Effect of the Gut Microbiome on the reduction of uremic toxins in patients with chronic kidney disease: A systematic review & Network meta-analysis

IntroductionChronic kidney disease (CKD) is associated with increased intestinal barrier permeability, leading to heightened inflammation and oxidative stress. These changes contribute to complications such as cardiovascular disease, anemia, altered mineral metabolism, and CKD progression. Interventions using prebiotics, probiotics, and synbiotics may help mitigate dysbiosis and improve intestinal barrier function. AimThis study conducted a network meta-analysis to evaluate the effectiveness of probiotics, prebiotics, and synbiotics in reducing uremic toxins produced by the gut microbiota in CKD patients. MethodA systematic review and network meta-analysis of randomized clinical trials (RCTs) was performed. The analysis focused on the use of prebiotics, probiotics, and synbiotics in CKD patients at stages 3 to 5, as per KDIGO guidelines, and their association with reductions in uremic toxins such as indoxyl sulfate (IS), p-cresyl sulfate (pCS), urea, and creatinine. The study follows the PRISMA statement. ResultsThe studies included 331 patients, primarily male, across CKD stages 3a to 5. The interventions showed a positive impact on the gut microbiota composition, leading to reductions in both free and total p-cresyl sulfate and indoxyl sulfate. ConclusionThe findings suggest that modulating the gut microbiota through these interventions can effectively reduce specific uremic toxins. However, further trials are necessary to better understand the microbiota modulation and its impact on intestinal bacterial composition. PROSPERO RegistrationCRD42023438901