Hemodialysis patients frequently exhibit altered gut microbiota and elevated indoxyl sulfate (IS) levels, a uremic toxin linked to negative health outcomes. This study explores how probiotic supplementation may be associated with changes in uremic toxins and sleep quality in hemodialysis patients through its relationship with gut microbiota. This open-label, randomized cohort study involved 80 hemodialysis patients with poor sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) Global Score. Participants were divided into two groups of 40. The probiotic group received two packs of freeze-dried Lactobacillus casei rhamnosus (Lcr35) daily for 12 weeks, while the control group received standard care. Baseline data, comorbidities, and blood samples were collected. Measurements included sleep quality (PSQI), uremic pruritus (5-D Itch Scale), heart rate variability, and plasma levels of IS and interleukin 6 (IL-6). Fecal samples were collected once before and once after probiotic treatment, and microbiota composition was assessed using 16S rRNA gene sequencing. Probiotic treatment significantly lowered IS levels in the probiotic group from 69.89 ± 31.51 μg/mL to 62.37 ± 29.84 μg/mL (P < 0.005), with no significant changes in the control group. The probiotic group also saw an increase in sleep duration from 5.83 ± 1.63 h to 6.30 ± 1.31 h (P < 0.01), unlike the control group. Sleep quality, measured by the PSQI Global Score, improved significantly in the probiotic group compared to the control group (P < 0.05). No significant changes were observed in heart rate variability, 5-D Itch Scale, or IL-6 levels. Microbiota enrichment showed significant improvements post-probiotic intervention. Bifidobacterium, Oscillospira, and Nitrospira increased in abundance, whereas TG5 decreased. Both Bifidobacterium and Oscillospira were linked to better sleep quality Both Bifidobacterium and Oscillospira were associated with better sleep quality, while Nitrospira and reduced TG5 levels correlated with lower IS levels. This study suggests that the reduction in indoxyl sulfate levels and the improvement in sleep quality following probiotic supplementation in hemodialysis patients may be linked to the modulation of gut microbiota.
Wang et al. (Fri,) studied this question.
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