Gut microbiome targeted approach- an opportunity for chronic kidney disease patients
: Prevention of cardiovascular events is one of our main goals in chronic kidney disease management. One of the promising candidates is altering dysbiotic gut flora through synbiotic supplementation in order to reduce the levels of gut derived uremic toxins and decrease microinflammation. Assessing the efficacy and safety of this potential strategy has been the main goal of our randomized, double-blind, placebo-controlled study. A total of 34 non-dialyzed chronic kidney disease patients, aged ≥18 years, with an estimated glomerular filtration rate between 15-45 ml/min, were randomized either to an intervention group (n=17) receiving synbiotic (Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium lactis, 32 billion colony forming units per day plus 3.2 g of inulin) during twelve weeks, or control group (n=17), receiving placebo during the same period of time. Synbiotic treatment significantly modified gut microbiome and consequently reduced serum level of indoxyl sulfate (ΔIS -21.5% vs 6.7%, p=0.0003), improved estimated glomerular filtration rate (ΔeGFR 12% vs. 8%, p=0.029) and decreased level of high sensitive C-reactive protein (hsCRP -39.5 vs –8.5%, p<0.001) in treated patients. Synbiotics could be available, safe, and an effective therapeutic strategy we could use in daily practice in order to decrease levels of uremic toxins and microinflammation in chronic kidney disease patients.