An observational study of effect of probiotic–prebiotic therapy on uremic toxins in patients with chronic kidney disease

Objectives: To determine the effect of use of prebiotic and probiotic supplements in patients with chronic kidney disease (CKD) on uremic toxins, that is, indoxyl sulfate (IS) and para-cresol sulfate (PCS). Materials and Methods: A prospective observational study was done on 25 pre-dialysis CKD patients, that is, CKD stage 3–5. Laboratory investigations were done at admission and after 8 weeks, which included blood urea nitrogen (BUN), creatinine, PCS, and IS. The patients were initiated on pre and probiotic therapy, two capsules containing 30 billion CFU thrice daily with meals (90 billion CFU/day) for 8 weeks. The patients were followed-up after an 8-week period. Results: Compared to pre-therapy, in post-therapy, there were significantly lower BUN (31.32 ± 13.35 mg/dL vs. 40.44 ± 15.85 mg/dL), creatinine (3.09 ± 1.35 mg/dL vs. 3.73 ± 1.44 mg/dL), serum PCS (90.2 vs. 129.4), and IS (51.1 vs. 84.3) ( P < 01). CKD stages 3, 4, and 5 were present in 7 (28%), 10 (40%), and 8 (32%) patients, respectively. CKD stage was not significantly associated with the decrease in uremic toxin levels. Conclusion: In CKD patients, oral intake of the pre–probiotic bacterial drug was safe and easily accepted. Pre–probiotic administration resulted in significant reductions in uremic toxins levels – BUN, creatinine, PCS, and IS.