Abstract
In the intestines, probiotics can produce antagonistic effects such as antibiotic–like compounds, bactericidal proteins such as bacteriocins, and encourage the production of metabolic end products that may assist in preventing infections from various pathobionts (capable of pathogenic activity) microbes. Metabolites produced by intestinal bacteria and the adoptions of molecular methods to cross-examine and describe the human microbiome have refreshed interest in the discipline of nephology. As such, the adjunctive administration of probiotics for the treatment of chronic kidney disease (CKD) posits that certain probiotic bacteria can reduce the intestinal burden of uremic toxins. Uremic toxins eventuate from the over manifestation of glucotoxicity and lipotoxicity, increased activity of the hexosamine and polyol biochemical and synthetic pathways. The accumulation of advanced glycation end products that have been regularly associated with a dysbiotic colonic microbiome drives the overproduction of uremic toxins in the colon and the consequent local pro-inflammatory processes. Intestinal dysbiosis associated with significant shifts in abundance and diversity of intestinal bacteria with a resultant and maintained uremia promoting an uncontrolled mucosal pro-inflammatory state. In this narrative review we further address the efficacy of probiotics and highlighted in part the probiotic bacterium Streptococcus thermophilus as an important modulator of uremic toxins in the gut of patients diagnosed with chronic kidney disease. In conjunction with prudent nutritional practices it may be possible to prevent the progression of CKD and significantly downregulate mucosal pro-inflammatory activity with the administration of probiotics that contain S. thermophilus.
Highlights
The intestinal microbiome is subject to daily perturbation that most probably occur with daily environmental/dietary and psychological/physical stressors as does the administration of antibiotics [1,2,3]
PubMed was searched using the MeSH headings chronic kidney disease or hemodialysis; gut dysbiosis; uremic toxins; uremia; p-cresyl sulphate; indoxyl sulphate, and these terms were combined with probiotics and prebiotics and synbiotics and S. thermophilus
The two clinical studies that did not report an efficacious outcome following the administration of probiotics, inducted subjects that were on hemodialysis due to poorly to non-functional kidneys [51,52], indicating that probiotic efficacy may depend on the stage of Chronic kidney disease (CKD) at inclusion into a clinical study (Table 1).Whereas efficacious studies with probiotics in this narrative review consisted of formulations that included S. thermophilus with subjects diagnosed with CKD that were not on hemodialysis
Summary
The intestinal microbiome is subject to daily perturbation that most probably occur with daily environmental/dietary and psychological/physical stressors as does the administration of antibiotics [1,2,3]. Uremic toxins have been postulated to exert harmful effects via augmentation of glucotoxicity and lipotoxicity, increased activity of the hexosamine and polyol biosynthetic/biochemical pathways, and the subsequent buildup of advanced glycation end products that are associated with a uremic dysbiotic colonic lumen [7]. The colonic environment is altered through the active accumulation of numerous endogenous microbial metabolites that include nitrogenous compounds such as oxalic acid, uric acid, and urea [9]. These intestinal bacteria-derived nitrogenous toxic metabolites that are normally excreted by the kidneys are transported across the intestinal epithelia and subsequently into the systemic circulation where they are retained [9]
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