The effect of synbiotics on serum indoxyl sulfate in maintenance haemodialysis patients

Abstract

Background: Indoxyl sulfate (IS) is a major uraemic toxin contributing to major cardiovascular morbidity and mortality. The aim of our study was to evaluate whether synbiotic (pre-and probiotic) therapy alters the gut microbiota and reduces serum concentrations of IS in hemodialysis patients. Methodology: 80 ESRD patients undergoing regular hemodialysis recruited (between January 2017 and March 2017) to a randomized, single-blind, placebo-controlled trial of synbiotic therapy over 6 weeks. The primary outcome was serum IS. Secondary outcomes included serum Creatinine, Blood Urea Nitrogen (BUN), Sodium, Potassium, Calcium, Phoshorus and C-reactive protein (CRP). Synbiotic (prebiotic 15 gm lactulose/day)1 (the probiot-ics include 5 bacterial strains; Lactobacillus rhamnosus, Lactoba-cillus acidophilus, Lactobacillus casai, Bifidobacterium brevis, Bifidobacterium longum in a dose of 10 billion CFU/10 gm prepared by Dairy and Food Microbiology Department of National Research Center). Result: Synbiotic therapy significantly reduced serum IS (13.5569.31 in intervention group Vs 3.18614.56 in the control group, P 0.001). Synbiotic therapy significantly reduced the levels of Creatinine, BUN, Phosphorus (P 0.001) and CRP (P 0.011). Conclusion: In hemodialysis patient, synbiotics significantly reduced serum IS, besides a marked reduction in serum Phosphorus and CRP without recorded adverse effects.