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Int J Nephrol. 2012;2012:673631. doi: 10.1155/2012/673631. Epub 2012 Dec 19.

Pre-, pro-, and synbiotics: do they have a role in reducing uremic toxins? A systematic review and meta-analysis.

Author information

1
School of Medicine, The University of Queensland, Brisbane, QLD 4006, Australia ; Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia ; Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia.

Abstract

OBJECTIVE:

This paper assessed the effectiveness of pre-, pro-, and synbiotics on reducing two protein-bound uremic toxins, p-cresyl sulphate (PCS) and indoxyl sulphate (IS).

METHODS:

English language studies reporting serum, urinary, or fecal PCS and/or IS (or their precursors) following pre-, pro-, or synbiotic interventions (>1 day) in human adults were included. Population estimates of differences in the outcomes between the pre- and the postintervention were estimated for subgroups of studies using four meta-analyses. Quality was determined using the GRADE approach.

RESULTS:

19 studies met the inclusion criteria, 14 in healthy adults and five in haemodialysis patients. Eight studies investigated prebiotics, six probiotics, one synbiotics, one both pre- and probiotics, and three studies trialled all three interventions. The quality of the studies ranged from moderate to very low. 12 studies were included in the meta-analyses with all four meta-analyses reporting statistically significant reductions in IS and PCS with pre- and probiotic therapy.

CONCLUSION:

There is a limited but supportive evidence for the effectiveness of pre- and probiotics on reducing PCS and IS in the chronic kidney disease population. Further studies are needed to provide more definitive findings before routine clinical use can be recommended.

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