Short-Term Effects of Pre/Probiotics on P-Cresol and Indoxyl-Sulphate Serum Concentrations During the Various Stages of Chronic Kidney Disease
Journal Title: Archives of Renal Diseases and Management - Year 2017, Vol 3, Issue 1
Abstract
Background: The uremic syndrome is provoked by a progressive number of compounds that are normally excreted by kidneys in healthy individuals. Indoxylsulphate (IXS) and p-cresylsulphate (PCS), have been found increased in subjects with end stage renal disease (ESRD) creating great harm to biological systems; these uremic toxins come from the intestinal bacterial fermentation of the proteins. The aim of our study is to evaluate the short-term effects after an administration of pre / probiotics in CKD patients, regarding the production and then the serum concentrations of free IXS and PCS (i.e. non-protein bound fraction) and total IXS and PCS ( i.e. sum of unbound and protein bound fraction). Methods: In our study , 26 patients with CKD stage 2-5 associated with hypertension and / or diabetes mellitus type 2 were enrolled, and administered with 2 g/day dose of pre-probiotics for four months: mixed oligofructose (prebiotic component) + Lactobacillus acidophilus and Bifidobacterium longum (probiotic component). In all patients, at the beginning of the study, kidney function tests, glucose metabolism, PTH and blood uric acid were evaluated. Free and total PCS and IXS were also measured. 20 control subjects with normal renal function were considered in relation to the same parameters. After 4 months 19 patients were re-evaluated in relation to the same parameters. Statistical differences were studied using the Student-t paired and unpaired tests. Results: The baseline values of IXS and PCS of the 26 patients were significantly higher compared with the normal subjects and importantly increased with the transition to the higher stage of CKD. The values in stage 2 - 3 CKD were significantly lower in respect to stage 4 – 5 CKD. Higher mean values of IXS and PCS in 12 diabetic subjects were highlighted, although not statistically significant compared to 14 hypertensive non-diabetic patients. The data after the use of pre - probiotics in 19 patients that completed the treatment protocol (5 patients were out of the study for non-compliance of the processing and 2 patients for dialysis entrance), showed increased concentrations of free and total IXS and PCS. Considering renal function, the use of pre - probiotics increased the concentration of free and total PCS and IXS in all conditions, while remaining significantly higher in patients at stage 4-5 rather than in the ones at the stage 2-3. The use of pre - probiotics increased the IXS and PCS serum concentrations, remaining significantly higher in diabetics rather than in hypertensive patients. In all periods, both baseline and after the uptake of pre-probiotics, the other measured parameters didn’t change except serum PTH that decreased significantly and Calcium increased even if not significantly Conclusions: In conclusion IXS and PCS can be considered as kidney function markers as well as have systemic toxic effects. Diabetes seems to increase the concentration of the two metabolites. The use of pre-probiotics should be started in the early stages of kidney failure and certainly for periods longer than four months. Pre-probiotics could aid in preventing renal osteodystrophy.
Authors and Affiliations
Panza Filomena, Duranti Diletta, Chiara Ralli, Basile Matteo, Bagnati Marco, Bellomo Giorgio
Keywords
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- EP ID EP343481
- DOI 10.17352/2455-5495.000017
- Views 49
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