Role of Probiotics on Dialysis Patients in End-Stage Kidney Disease: A Systematic Review

The prevalence of chronic kidney disease (CKD) has been increasing all over the world due to the high-risk factors of metabolic syndrome. But, unfortunately, the cost of dialysis and the scarcity of dialysis center and dialysate are making it more complex for the people in least developed countries. Probiotics are being studied as a potential treatment option for chronic kidney disease, especially in the dialysis patients. The aim of this review is to investigate the effects of probiotics administration in dialysis patients in end-stage kidney disease. A systemic search was conducted on MEDLINE database from 2002 to 2023 using key terms related to dialysis, end-stage kidney disease and probiotics. Fifteen studies met eligibility criteria, among which thirteen were on hemodialysis patients and others on peritoneal dialysis patients. The results of the studies revealed that probiotics have some significant effect on gut dysbiosis, gastrointestinal symptoms, uremic toxins, inflammation and overall quality of life of dialytic patients. Studies showed that administration of probiotics inhibit the growth of pathogenic bacteria as well as production of protein-bound uremic toxins (i.e. indoxyl sulfate and p-cresol sulfate) which can not be fully excreted by dialysis. The level of serum TNF-, IL-5 and IL-6 were significantly decreased in peritoneal dialysis patients. However, further investigations must be carried out with larger sample size with larger study duration and wit different probiotics or synbiotics preparations to obtained more specific explanations of the effects and mechanisms of probiotics to counteract the disease progression on dialysis patients in end-stage kidney disease.