Effect of probiotic-prebiotic supplementation with diet counseling in chronic kidney disease

Chronic kidney disease (CKD) is a progressive disease leading to requirement of renal replacement therapy (RRT) over a period of time. Limited availability and high cost of RRT in many countries necessitates the researchers to focus on either prevention or slowing the progression of CKD. High dose probiotics have been hypothesized to metabolize the nitrogenous waste products, thus delaying the requirement of dialysis. The purpose of this short term intervention study was to study the effect of probiotic-prebiotic therapy and diet counseling on nutrition, renal progression, and overall health of CKD patients. Thirty predialysis CKD patients (21 males, 9 females) were included in the study. The diet charts were designed according to the underlying nutritional status and blood parameters. Calorie intake was 30-40kcal/kg; proteins 0.6-0.8g/kg (with at least 50% high biological value); potassium 1.5-2gm./day; and phosphorus <1gm./day. All patients were prescribed enteric coated gelatin capsules containing lyophilized Streptococcus Thermophilus, Lactobacillus Acidophilus, and Bifidobacterium Longum, in a dose of 15 billion colony forming units along with 100mg Lactitol monohydrate as prebiotic. Each patient received two capsules three times a day with each meal. The mean age was 45 years (range 18-68). The statistical analysis was done using ‘RGui’ software version 2.13.0 and the outcomes were tested using paired t-test at 5% level of significance. The mean calorie intake increased from 1479kcal/day to 1869kcal/day (p<0.0005), with significant reduction in protein, phosphorus and potassium intake. There was significant improvement in body mass index (p=0.002) and serum albumin levels (p=0.005). All but four patients showed improvement or stabilisation of glomerular filtration rate (GFR), and the mean GFR improved from 24.72ml/min to 27.73ml/min (p=0.03). There was also significant improvement in triglyceride and LDL cholesterol levels. Twenty five patients showed improvement in five point quality of life visual analogue score, while no patient reported any significant adverse event. In conclusion, this short term study of diet counselling with probiotic supplementation showed significant improvement in various parameters of CKD necessitating a longer term study. [Copyright &y& Elsevier]