MP431EFFECTS OF PROBIOTIC SUPPLEMENTATION ON UREMIC TOXINS LEVELS IN NON-DIALYSIS CKD PATIENTS

Abstract

INTRODUCTION AND AIMS: Probiotics have been suggested as a potential therapy in Chronic Kidney Disease (CKD). They emerged in a context in which the dysbiosis in gut microbiota has become an important factor involved in the progression and complications of CKD. The aim of this study was to evaluate the effects of probiotic supplementation on inflammatory markers and uremic toxins plasma levels in nondialysis CKD patients. METHODS: This randomized, double-blind, placebo-controlled study was performed on 20 non-dialysis CKD patients who were randomly assigned to receive probiotic supplement (n= 10; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacterialongum - 90 billion CFU per day) or placebo (n = 10) daily for three months. C-reactive protein (CRP), interleukin-6 (IL-6) and lipopolysaccharides (LPS) were analyzed by Immunoenzymatic Assay (ELISA). Uremic toxins, indoxyl sulfate (IS), p-cresyl sulfate (p-CS) and indole-3-acetic acid (IAA) were obtained by Fluorescence High Performance Liquid Chromatography and, trimethylamine-Noxide (TMAO) by Liquid chromatography-mass spectrometry LC-MS/MS. The percentage of changes in the plasma levels of evaluated markers were compared between groups. RESULTS: Sixteen patients completed the study (probiotic group: n=7, 64.2 ± 7.2 yrs, 5 men, eGFR 34.6±12.7mL/min/1.73m2; placebo group: n=9, 63.4 ± 8.1yrs, 5 men, eGFR 37.7±13.7 mL/min/1.73m2). After probiotic supplementation there was a significant increase in IL-6 plasma levels (Table 1). There was no significant change in the average levels of CRP and uremic toxins assessed in probiotic group, in contrast, IAA levels were reduced after 3 months in placebo group. The percentage of changes were not different between groups, however, evaluating all patients (both groups), there was a positive correlation between the percentage (%) of change of p-CS plasma levels and the % of change of IL-6 plasma levels (r = 0.53, p= 0.04). CONCLUSIONS: Probiotic supplementation failed to reduce plasma concentration of inflammatory markers and uremic toxins in CKD patients. Further studies need to confirm the unexpected pro-inflammatory potential of probiotics. (Table Presented).