The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

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#biomarkers #cardiovascular-diseases #gastrointestinal-microbiome #humans #inflammation

The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

March et al., 2020 | J Ren Nutr | Meta Analysis

Citation

March Daniel S, Jones Arwel W, ... Burton James O. The Efficacy of Prebiotic, Probiotic, and Synbiotic Supplementation in Modulating Gut-Derived Circulatory Particles Associated With Cardiovascular Disease in Individuals Receiving Dialysis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Ren Nutr. 2020-Jul;30(4):347-359. doi:10.1053/j.jrn.2019.07.006

Abstract

OBJECTIVE: This systematic review and meta-analyses provide an up-to-date synthesis on the effects of supplementation on circulating levels of toxic metabolites, markers of uremia and inflammation, blood lipids, and other clinical outcomes. METHODS: Seventeen databases were searched, supplemented with internet and hand searching. Randomized controlled trials of adult end-stage renal-disease individuals receiving either hemodialysis or peritoneal dialysis were eligible. Trials were restricted to those which had administered a prebiotic, probiotic, or synbiotic as an oral supplement. Primary outcomes were measures of circulating endotoxin, indoxyl-sulphate, and p-cresyl sulfate. RESULTS: Twenty-one trials were eligible (1152 randomized participants), of which 16 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesized data indicated that supplementation significantly reduced circulating levels of endotoxin (standardized mean difference, -0.61; 95% confidence interval, -1.03 to -0.20; P = .004; I2 = 0%), indoxyl-sulphate (-0.34; -0.64 to -0.04; P = .02; I2 = 0%), and p-cresyl sulfate (-0.34; -0.61 to -0.07; P = .01; I2 = 0%). For secondary outcomes, supplementation significantly reduced gastrointestinal symptoms (-0.54; -1.02 to -0.07; P = .02; I2 = 0%). CONCLUSIONS: Supplementation reduces toxic metabolites associated with cardiovascular disease and mortality in individuals receiving dialysis. However, the majority of trials included were low in quality.

Key Findings

Twenty-one trials were eligible (1152 randomized participants), of which 16 trials were considered to have a high risk of bias. The number of trials available for meta-analysis varied for each primary outcome. Synthesized data indicated that supplementation significantly reduced circulating levels of endotoxin (standardized mean difference, -0.61; 95% confidence interval, -1.03 to -0.20; P = .004; I2 = 0%), indoxyl-sulphate (-0.34; -0.64 to -0.04; P = .02; I2 = 0%), and p-cresyl sulfate (-0.34;

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population adult end
Sample Size 16
Age Range See abstract
Condition inflammation

MeSH Terms

  • Biomarkers
  • Cardiovascular Diseases
  • Gastrointestinal Microbiome
  • Humans
  • Inflammation
  • Lipids
  • Prebiotics
  • Probiotics
  • Randomized Controlled Trials as Topic
  • Renal Dialysis
  • Synbiotics
  • Uremia

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: prebiotic-digestive

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09