Influence of prebiotic and probiotic supplementation on the progression of chronic kidney disease. Synbiotic Supplementations for Azotemia in Patients With Chronic Kidney Disease: a Randomized Controlled Trial. Uric acid and chronic kidney disease: new understanding of an old problem. SYNbiotics Easing Renal failure by improving Gut microbiologY (SYNERGY): a protocol of placebo-controlled randomised cross-over trial Uric acid as a risk factor for progression of non-diabetic chronic kidney disease? The Mild to Moderate Kidney Disease (MMKD) Study Predictors of heart rate variability and its prognostic significance in chronic kidney disease. Long-term outcomes of survivors of ICU acute kidney injury requiring renal replacement therapy: a 10-year prospective cohort study
BACKGROUND One of the main goals in chronic kidney disease ( CKD ) patients is to diminish the accumulation of uremic toxins and to slow the progression of renal failure . We investigated whether prebiotic and probiotic supplementation along with low protein diet retards the progression of CKD . METHODS This is a 12-month prospect i ve observation study with a r and omized control and open-label design . A total of 24 stable CKD stage III to V patients , who are not on renal replacement therapy , were enrolled in this study . Patients were r and omly assigned to 2 groups : low protein diet + prebiotic + probiotic supplementation ( N.=12 ) , receiving 3 tablets of prebiotic + probiotic supplementation daily for 6 months , and the control group receiving low protein diet only ( N.=12 ) . We examined the effects of prebiotic and probiotic supplementation on estimated glomerular filtration rate ( eGFR ) in CKD . RESULTS The declining GFR  during prebiotic and probiotic supplementation were significantly lower ( -11.6±8.6 vs. -3.4±4.6 mL/min per 1.73 m2 per year , 95 % CI -6.45 - -9.86 , P<0.001 ) than those with low protein diet alone . CONCLUSIONS Prebiotic and probiotic supplementation along with low protein diet delayed the progression of CKD INTRODUCTION Chronic kidney disease ( CKD ) is a progressive and irreversible impairment of kidney function ; if it progresses to the end-stage of CKD , dialysis or kidney transplant is needed . In general , there are no definitive treatment to slow the progression of CKD . This study aim ed to determine the effect of synbiotic supplementations on azotemia in patients with CKD . MATERIAL S AND METHODS A r and omized controlled trial was conducted on 66 patients with CKD ( stages 3 and 4 ) . The participants were r and omly divided into 2 groups to receive synbiotic supplement , 1000 mg/d , and placebo ( 2 capsules a day ) for 6 weeks . At the beginning and end of the study , blood parameters and kidney function were evaluated . RESULTS Of the 66 patients studied , 16 patients ( 24.2 % ) were women and 50 ( 75.8 % ) were men . The mean age and body mass index of the participants were 61 ± 7.65 years and 28.52 ± 4.06 kg/m2 , respectively .  The level of blood urea nitrogen showed a significant reduction following the intake of synbiotic supplement ( from 40.80 ± 22.11 mg/dL to 36.14 ± 20.52 mg/dL , P = .01 ) . Serum creatinine , uric acid , and other indicators of kidney function showed no significant change . CONCLUSIONS The intake of synbiotic supplement could reduce blood urea nitrogen in patients with CKD in stages 3 and 4 ; however , it had no effect on the other markers of kidney function Although an elevation of serum uric acid level is often associated with chronic kidney disease ( CKD ) , it remains controversial whether hyperuricemia per se is a true risk factor for the development or aggravation of CKD . Recent epidemiologic studies in healthy population s or in subjects with established kidney disease have reported the independent role of uric acid in lowering glomerular filtration rate and increasing the risk for new-onset kidney disease . Furthermore , lowering uric acid in patients with established renal disease has been reported to stabilize renal function independent of other confounders , suggesting a causative role of elevated uric acid in progression of CKD , rather than as an incidental finding related to CKD severity . In this manuscript we will discuss the potential role of uric acid in the development and aggravation of CKD based on epidemiologic , clinical and experimental studies . Given the worldwide epidemic of CKD , the importance of identifying modifiable risk factors of CKD , and the clinical implication of hyperuricemia in CKD , we propose large r and omized clinical trials to investigate whether uric acid-lowering therapy can slow the progression of CKD Background Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease ( CKD ) through pre- and /probiotic supplementation may inhibit the development of key nephrovascular toxins . To date , quality intervention trials investigating this novel treatment in CKD are lacking . The aim of SYNERGY is to assess the effectiveness of synbiotics ( co-administration of pre- and probiotics ) as a potential treatment targeting the synthesis of uremic toxins , specifically , indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) . Methods / design Thirty-seven patients with moderate to severe CKD ( Stage IV and V , pre-dialysis ) will be recruited to a double-blind , placebo-controlled , r and omised cross-over trial . Patients will be provided with synbiotic therapy or placebo for 6 weeks , with a 4 week washout before cross-over . The primary outcome is serum IS , total and free ( unbound ) concentrations , measured using ultra-performance liquid chromatography . Secondary outcomes include serum PCS , total and free ( unbound ) concentrations ; cardiovascular risk , measured by serum lipopolysaccharides , serum trimethylamine-N-oxide ( TMAO ) and inflammation and oxidative stress markers ; kidney damage , measured by 24 hour proteinuria and albuminuria , estimated glomerular filtration rate and renal tubule damage ( urinary kidney injury molecule-1 ) ; patients ’ self assessed quality of life ; and gastrointestinal symptoms . In addition , the effects on the community structure of the stool microbiota will be explored in a subset of patients to vali date the mechanistic rationale underpinning the synbiotic therapy . Discussion IS and PCS are two novel uremic toxins implicated in both cardiovascular disease ( CVD ) and progression of CKD . Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted , tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations . This trial will provide high quality ‘ proof-of-concept ’ data to eluci date both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits . Considering the potential of pre- and probiotics to not only shift toxin levels , but to also impede CVD and CKD progression , SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy . Trial Registration Universal Trial Number : U1111 - 1142 - 4363 . Australian New Zeal and Clinical Trials Registry Number : ACTRN12613000493741 , date registered : 2nd May 2013 The kidney is one of the organs most prominently affected by aging . This can be seen by a loss of renal mass which is caused by a decrease in the number of nephrons result ing in hyperfiltration , hypertrophy and elevations in glomerular pressure . The factors influencing aging of the kidney are not fully eluci date d. Epidemiological , experimental and interventional studies result ed in inconsistent results and have not firmly established whether uric acid levels affect progression of Chronic Kidney Disease ( CKD ) . Therefore , we analyzed whether uric acid levels predict the progression of CKD in the Mild to Moderate Kidney Disease Study comprising at baseline 227 Caucasian patients aged 18 - 65 years with primary non-diabetic CKD of various degrees of renal impairment . Of them , 177 completed a prospect i ve follow-up of 7 years . Primary endpoint was progression of CKD defined as doubling of baseline serum creatinine and /or terminal renal failure . Patients who reached a progression endpoint ( n = 6 5 ) were significantly older , had higher baseline serum creatinine and protein excretion rates as well as lower Glomerular Filtration Rate ( GFR ) . Uric acid levels were only higher in patients with progression of disease when patients with uric acid-lowering drugs were excluded from the analysis . Cox regression analysis revealed that increasing uric acid levels predict disease progression only when the analysis was not adjusted for baseline kidney function parameters . As soon as we adjusted the analysis for GFR and proteinuria this association completely vanished . In summary , our prospect i ve 7 year follow-up study in patients with non-diabetic primary CKD did not support uric acid as an independent predictor for CKD progression BACKGROUND Heart rate variability ( HRV ) , a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease ( CVD ) , has not been systematic ally studied in nondialysis chronic kidney disease ( CKD ) . METHODS HRV was assessed using 24-h Holter monitoring in 305 subjects from the Renal Research Institute-CKD Study , a four-center prospect i ve cohort of CKD ( Stages 3 - 5 ) .  Multiple linear regression was used to assess predictors of HRV ( both time and frequency domain ) and Cox regression used to predict outcomes of CVD , composite of CVD/death and end-stage renal disease ( ESRD ) . RESULTS A total of 47 CVD , 67 ESRD and 24 death events occurred over a median follow-up of 2.7 years . Lower HRV was significantly associated with older age , female gender , diabetes , higher heart rate , C-reactive protein and phosphorus , lower serum albumin and Stage 5 CKD . Lower HRV ( mostly frequency domain ) was significantly associated with higher risk of CVD and the composite end point of CVD or death . Significantly , lower HRV ( frequency domain ) was associated with higher risk of progression to ESRD , although this effect was relatively weaker . CONCLUSIONS This study draws attention to the importance of HRV as a relatively under recognized predictor of adverse cardiovascular and renal outcomes in patients with nondialysis CKD . Whether interventions that improve HRV will improve these outcomes in this high-risk population deserves further study Background Acute kidney injury ( AKI ) requiring renal replacement therapy ( RRT ) is associated with high in-hospital morbidity and mortality in critically ill patients . Long-term outcomes have received little attention . Methods The aim of this study was to characterize AKI – chronic kidney disease ( CKD ) nexus in critically ill patients with AKI ( RIFLE class F ) . We performed a single-centre prospect i ve observational study of 425 consecutive critically ill patients with AKI requiring RRT . None of these patients had pre-existing kidney disease . Primary outcomes were vital status and renal function at hospital discharge and at 5 and 10 years of follow-up . Results The overall in-hospital mortality of the study cohort was 47 % , the mortality rates at 1 , 5 and 10 years were 65 , 75 and 80 % , respectively . At hospital discharge , recovery of renal function was complete in 56 % of survivors . None of these patients developed CKD during follow-up . Ninety percent of the 100 survivors with partial recovery of renal function had ongoing CKD during long-term follow-up . CKD progressed to end-stage renal disease ( ESRD ) in 12 patients ( 3 % of the cohort or 5 % of survivors ) . The patients with post-AKICKD had a higher prevalence of hypertension , a higher rate of fatal cardiac diseases and a higher all-cause death rate . Conclusion Long-term survival of critically ill patients with AKI requiring RRT is poor and determined by the development of de novo CKD . There is a need for close follow-up of patients surviving AKI to prevent progressive CKD and to reduce associated lethal cardiac events
Most of the included articles reported positive effects in renal function and decreased levels of urea , blood urea nitrogen , ammonia , plasma p-cresol , p-cresyl sulfate , and indoxyl sulfate
ABSTRACT Chronic kidney disease ( CKD ) is a syndrome caused by the progressive reduction of renal function .
This study aim ed to systematic ally examine the effects of supplementation with probiotics in the treatment of CKD .