Discussion
CKD, fibrosis, intestinal dysbiosis, kidney dysfunction, sepsis-induced AKI, AKI, sepsis
ADVERSE EVENTS, FIBROSIS, KIDNEY DYSFUNCTION, SECONDARY, SEPSIS
In this double-blind randomized clinical trial carried out in patients with AKI secondary to sepsis, we found for the first time that the administration of probiotics for 7 days did not improve KFR compared with placebo treatment, but it had a trend to decrease the mortality rate, in addition to having an acceptable safety profile.KFR was observed in half of the patients in this study during the 7-day period, which was similar to what was previously reported for patients with sepsis-induced AKI [It is plausible to think that uremic toxins derived from intestinal dysbiosis promote kidney dysfunction and fibrosis, a clear example is Trimethylamine-N-oxide (TMAO), a gut microbial-dependent metabolite, plays a direct contributory role in the development and progression of CKD and was even associated with an increased risk of dying [We showed that the administration of probiotics tended to decrease mortality in rats. AKI related to sepsis has a poor prognosis. A meta-analysis reported that 45% of affected patients die during their stay in intensive care units and up to 49% die during hospitalization [Regarding other parameters that have been used to evaluate renal function in patients with AKI, such as the need for KRT and sCr concentrations, we did not observe a positive effect of the administration of probiotics. However, serum urea concentrations only improved significantly in the probiotic group, not in the placebo group, although no significant differences were found between them. This effect could be explained by the modulation of intestinal dysbiosis with probiotics and thus the attenuation of urea generation by intestinal bacteria [The finding of higher urinary volume and serum sodium levels in the placebo group than in the probiotics group could be explained by the excretion of free water and thus vascular decongestion. We believe this difference does not profoundly impact the clinical course of these patients since urinary volume and sodium remained within ranges considered safe [It is important to comment on the values of eGFR observed during the long-term follow-up of these patients (∼1 year), which was 39 mL/min/1.73 mConsidering the reported adverse events, we believe that the administration of probiotics to patients with sepsis-induced AKI was well tolerated and had an acceptable safety level. No adverse events were considered serious, and none of the patients stopped treatment due to any adverse events reported.For decades, different therapeutic agents have been investigated for the management of AKI associated with sepsis with disappointing results; the use of agents such as statins [