Renal Health Improvement in Diabetes through Microbiome Modulation of the Gut–Kidney Axis with Biotics: A Systematic and Narrative Review of Randomized Controlled Trials
Abstract
:1. Introduction
2. Methods
2.1. Study Protocol
2.2. Data Sources and Search Strategy
2.3. Eligibility Criteria and Screening
2.4. Data Extraction
2.5. Risk of Bias Assessment
3. Results
3.1. Search Results
3.2. Trial Characteristics
3.3. Risk of Bias Assessment
3.4. Effect on Serum Creatinine (Cr)
3.5. Effect on Estimated Glomerular Filtration Rate (eGFR)
3.6. Effect on Urea or Blood Urea Nitrogen (BUN)
3.7. Effect on Urine Albumin/Creatinine Ratio (Alb/Cr)
3.8. Effect on Uric Acid
3.9. Effect on Serum Sodium, Potassium, and Phosphorus
3.10. Effect on Serum Albumin
3.11. Effect on Other Renal Biomarkers
4. Discussion
4.1. Main Findings
4.2. Is there an Optimum Nutraceutical Formulation?
4.3. Findings from Previous Reviews
4.4. Gut–Kidney Axis in Diabetes and Diabetic Kidney Disease
4.5. Mechanisms of Action of Microbiome-Modulating Nutraceuticals
4.6. Limitations
5. Conclusions and Recommendations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Type of Nutraceutical | Study Design, Country | Participant Demographics * Sample Size and Sex (n, F/M) Age (Mean ± SD; Years) BMI (Mean ± SD; kg/m2) | Control/Placebo Substance | Intervention Nutraceutical | Dose × Frequency | Trial Duration | Marker and Effect (If Significant) | Control/Placebo Change Φ | Intervention Change Φ | Overall Effect and Statistical Significance Φ | Author, Year | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Control/Placebo | Intervention | |||||||||||
Probiotic (SS) | PG, DB, RCT (Iran) | T2D-DN n = 20 (10M/10F) 53.6 ± 7.19 26.58 ± 3.27 | T2D-DN n = 20 (9M/11F) 56.9 ± 8.1 26.68 ± 3.19 | Conventional soy milk | Probiotic soy milk containing Lactobacillus plantarum A7 (2 × 107 CFU/mL) | 200 mL/d | 8 weeks | ↓ Serum Cr (mg/dL) (§) | Cb: 1.03 ± 0.16 Ce: 1.00 ± 0.14 CΔ: −0.03 ± 0.08 | Ib: 1.01 ± 0.11 Ie: 0.83 ± 0.16 IΔ: −0.17 ± 0.11 (Ib vs. Ie p < 0.05) (§) | CΔ vs. IΔ (adjusted) p < 0.0001 (§) | [38] χ |
↑ eGFR (mL·min−1 (1.73 m2)−1) (§) | Cb: 72.1 ± 9.1 Ce: 75.4 ± 11.13 CΔ: 3.2 ± 8.4 | Ib: 71.5 ± 9.5 Ie: 87.5 ± 14.2 IΔ: 15.9 ± 10.8 (Ib vs. Ie p < 0.05) (§) | CΔ vs. IΔ (adjusted) p < 0.0001 (§) | |||||||||
Serum Phosphorous (mg/dL) | Cb: 4.38 ± 0.67 Ce: 4.44 ± 0.59 CΔ: 0.05 ± 0.5 | Ib: 4.48 ± 0.47 Ie: 4.33 ± 0.44 IΔ: −0.14 ± 0.10 | CΔ vs. IΔ (adjusted) p = 0.106 (No significant effect) | |||||||||
Probiotic (SS) | PG, DB, RCT (Iran) | T2D-DN n = 20 (10M/10F) 53.6 ± 7.19 26.58 ± 3.27 | T2D-DN n = 20 (9M/11F) 56.9 ± 8.1 26.68 ± 3.19 | Conventional soy milk | Probiotic soy milk containing Lactobacillus plantarum A7 (2 × 107 CFU/mL) | 200 mL/d | 8 weeks | ↓ Serum IL-18 (pg/mL) (§) | Cb: 335.14 ± 266.65 Ce: 326.1 ± 260.34 CΔ: −9.03 ± 18.65 | Ib: 286.14 ± 207.8 Ie: 236.96 ± 181.87 IΔ: −49.18 ± 48.22 | CΔ vs. IΔ (adjusted) p = 0.002 (§) | [39] χ |
↓ Urine Alb/Cr (mg/g) | Cb: 147.0 ± 38.6 Ce: 141.36 ± 37.9 CΔ: −5.7 ± 15.04 | Ib: 145.8 ± 29.1 Ie: 129.36 ± 31.9 IΔ: −16.5 ± 12.2 | CΔ vs. IΔ (adjusted) p = 0.03 (§) | |||||||||
↓ Serum sialic acid (mg/dL) (§) | Cb: 232.33 ± 40.79 Ce: 227.95 ± 40.5 CΔ: 4.37 ± 9.91 | Ib: 223.6 ± 44.72 Ie: 206.2 ± 43.24 IΔ: −17.4 ± 11.43 | CΔ vs. IΔ (adjusted) p = 0.001 (§) | |||||||||
Probiotic (SS) | PG, DB, RCT (Iran) | T2D-DN n = 20 (10M/10F) 53.60 ± 1.60 26.58 ± 0.73 | T2D-DN n = 20 (9M/11F) 56.90 ± 1.81 26.68 ± 0.71 | Conventional soy milk | Probiotic soy milk containing Lactobacillus plantarum A7 (2 × 107 CFU/mL) | 200 mL/d | 8 weeks | ↓ NGAL (ng/mL) (§) | Cb: 1667.41 ± 420.66 Ce: 2417.61 ± 392.47 (Cb vs. Ce p = 0.75) | Ib: 1808.73 ± 510.20 Ie: 1164.68 ± 379.64 (Ib vs. Ie p = 0.07) | CΔ vs. IΔ (adjusted) p = 0.05 (§) | [46] χ |
↑ sTNFR1 (ng/mL) (§) | Cb: 424.80 ± 47.04 Ce: 348.79 ± 80.89 (Cb vs. Ce p = 0.04) | Ib: 292.53 ± 40.87 Ie: 353.33 ± 88.02 (Ib vs. Ie p = 0.95) | CΔ vs. IΔ (adjusted) p = 0.03 (§) | |||||||||
↓ Cys-C (ng/mL) (§) | Cb: 50.40 ± 3.84 Ce: 58.86 ± 5.44 (Cb vs. Ce p = 0.09) | Ib: 47.85 ± 2.76 Ie: 26.82 ± 6.70 (Ib vs. Ie p = 0.12) | CΔ vs. IΔ (adjusted) p = 0.01 (§) | |||||||||
↓ PGRN (ng/mL) (§) | Cb: 328.85 ± 76.18 Ce: 399.56 ± 105.20 (Cb vs. Ce p = 0.60) | Ib: 339.66 ± 109.61 Ie: 180.90 ± 69.25 (Ib vs. Ie p = 0.83) | CΔ vs. IΔ (adjusted) p = 0.01 (§) | |||||||||
Probiotic (SS) | DB, R, PG, PC (Sweden) | T2D-Abdominal obesity n = 15 (11M/4F) 65 ± 5 30.7 ± 4.0 | T2D-Abdominal obesity n = 15 (12M/3F) 66 ± 6 30.6 ± 4.5 (low-dose group) | Capsule with mildly sweet tasting powder in an aluminum laminate stick pack | Capsule containing low-dose Lactobacillus reuteri DSM 17938 (108 CFU/capsule) | 1 capsule/d | 12 weeks | Urine Alb/Cr | Cb: 2.0 ± 2.9 Ce: 2.2 ± 2.3 | Ib: 2.2 ± 5.9 Ie: 3.1 ± 8.3 | No significant effect | [47] φ |
T2D-Abdominal obesity n = 14 (11M/3F) 64 ± 6 32.3 ± 3.4 (high-dose group) | Capsule with mildly sweet tasting powder in an aluminum laminate stick pack | Capsule containing high-dose Lactobacillus reuteri DSM 17938 (1010 CFU/capsule) | 1 capsule/d | 12 weeks | Urine Alb/Cr | Cb: 2.0 ± 2.9 Ce: 2.2 ± 2.3 | Ib: 6.7 ± 15.9 Ie: 6.5 ± 13.4 | No significant effect | ||||
Probiotic (SS) | R, DB, CT (Iran) | DN n = 30 (Sex NS) 60.3 ± 8.5 31.1 ± 4.6 | DN n = 30 (Sex NS) 62.7 ± 9.1 30.3 ± 5.6 | Control honey | Probiotic honey containing viable and heat-resistant Bacillus coagulans T4 (108 CFU/g) | 25 g/d | 12 weeks | BUN (mg/dL) | Cb: 19.6 ± 6.2 Ce: 19.9 ± 7.3 CΔ: 0.3 ± 4.3 | Ib: 19.6 ± 7.1 Ie: 19.3 ± 6.8 IΔ: 0.3 ± 2.1 | CΔ vs. IΔ p = 0.54 (No significant effect) | [48] |
Serum Cr (mg/dL) | Cb: 1.3 ± 0.5 Ce: 1.5 ± 0.8 CΔ: 0.2 ± 0.7 | Ib: 1.6 ± 0.6 Ie: 1.5 ± 0.5 IΔ: −0.1 ± 0.5 | CΔ vs. IΔ p = 0.09 (No significant effect) | |||||||||
Probiotic (MS) | R, DB, PC, CT (Iran) | n = 27 (Sex NS) 52.59 ± 7.14 30.17 ± 4.23 | n = 27 (Sex NS) 50.51 ± 9.82 31.61 ± 6.36 | 100 mg fructo-oligosaccharide with lactose/capsule | Freeze-dried Lactobacillus acidophilus (2 × 109 CFU), L. casei (7 × 109 CFU), L. rhamnosus (1.5 × 109 CFU), L. bulgaricus (2 × 108 CFU), Bifidobacterium breve (2 × 1010 CFU), B. longum (7 × 109 CFU), Streptococcus thermophilus (1.5 × 109 CFU), and 100 mg FOS with lactose carrier per capsule | 1 capsule/d | 8 weeks | Uric Acid (mg/dL) | Cb: 4.73 ± 0.27 Ce: 4.88 ± 0.24 CΔ: 0.15 ± 0.21 (Cb vs. Ce p = 0.47) | Ib: 4.71 ± 0.27 Ie: 5.51 ± 0.28 IΔ: 0.8 ± 0.27 (Ib vs. Ie p = 0.008) (§) | CΔ vs. IΔ p = 0.07 (No significant effect) | [49] |
Probiotic (MS) | DB, R, PG, PC (Malaysia) | n = 68 (34M/34F) 54.2 ± 8.3 29.3 ± 5.3 | n = 68 (31M/37F) 52.9 ± 9.2 29.2 ± 5.6 | Organoleptically similar sachets without probiotic | Sachets containing viable microbial cell preparation of Lactobacillus acidophilus, L. casei, L. lactis, Bifidobacterium bifidum, B. longum and B. infantis (6.0 × 1010 CFU/d total) mixed in water | 2 sachets/d | 12 weeks | ↓ Urea (mmol/L) (§) | Cb: 4.03 ± 0.89 C1/2: 4.07 ± 1.10 Ce: 4.24 ± 1.14 (Cb vs. Ce p = 0.081) | Ib: 4.26 ± 1.29 I1/2: 4.03 ± 1.00 Ie: 4.04 ± 1.04 (Ib vs. Ie p = 0.086) | CΔ vs. IΔ (ITT) p < 0.05 (§) | [50] |
Serum Cr (µmol/L) | Cb: 72.10 ± 18.84 C1/2: 71.95 ± 18.60 Ce: 75.17 ± 18.93 (Cb vs. Ce p < 0.05) (§) | Ib: 69.20 ± 17.36 I1/2: 70.87 ± 18.70 Ie: 72.26 ± 19.73 (Ib vs. Ie p < 0.05) (§) | CΔ vs. IΔ (ITT) p = 0.329 (No significant effect) | |||||||||
eGFR (mL/min) | Cb: 73.66 ± 13.38 C1/2: 73.91 ± 13.58 Ce: 68.89 ± 13.55 (Cb vs. Ce p < 0.05) (§) | Ib: 74.45 ± 18.5 I1/2: 74.14 ± 16.94 Ie: 73.07 ± 17.13 (Ib vs. Ie p = 0.710) | CΔ vs. IΔ (ITT) p = 0.147 (No significant effect) | |||||||||
Serum Sodium (mmol/L) | Cb: 137.9 ± 2.5 C1/2: 138.8 ± 2.9 Ce: 138.5 ± 3.1 (Cb vs. Ce p = 0.167) | Ib: 138.5 ± 2.2 I1/2: 138.9 ± 2.7 Ie: 138.1 ± 3.5 (Ib vs. Ie p = 0.147) | CΔ vs. IΔ (ITT) p = 0.235 (No significant effect) | |||||||||
Serum Potassium (mmol/L) | Cb: 4.40 ± 0.40 C1/2: 4.34 ± 0.36 Ce: 4.37 ± 0.43 (Cb vs. Ce p = 0.360) | Ib: 4.42 ± 0.30 I1/2: 4.42 ± 0.31 Ie: 4.35 ± 0.31 (Ib vs. Ie p = 0.060) | CΔ vs. IΔ (ITT) p = 0.164 (No significant effect) | |||||||||
Probiotic (MS) | RCT (China) | T2D-DN n = 34 (12M/22F) 56.12 ± 8.23 26.44 ± 2.78 | T2D-DN n = 42 (15M/27F) 55.96 ± 8.45 27.51 ± 3.22 | Starch | Probiotic supplements containing Bifidobacterium bifidum, Lactobacillus acidophilus, Streptococcus thermophilus (3.2 × 109 CFU/d in total) | 1 capsule/d | 12 weeks | ↓ Urine Alb/Cr (mg/g) (§) | Cb: 99. 66 ± 25.24 Ce: 87.71 ± 23.01 | Ib: 101.60 ± 22.17 Ie: 67.53 ± 20.11 | Ce vs. Ie p < 0.05 (§) | [51] |
eGFR (ml·min−1 (1.73 m2) −1) | Cb: 83.12 ± 7.2 Ce: 84.28 ± 7.13 (Cb vs. Ce p = 0.77) | Ib: 82.8 ± 8.72 Ie: 84.34 ± 6.97 (Ib vs. Ie p = 0.45) | Ce vs. Ie p = 0.08 (No significant effect) | |||||||||
Probiotic (MS) | R, DB, PC (Iran) | DN n = 30 (28/30 = T2D) (2/30 = T1D) Sex NS 60.9 ± 4.4 26.3 ± 3.2 | DN n = 30 (28/30 = T2D) (2/30 = T1D) Sex NS 58.9 ± 8.8 25.3 ± 2.3 | Starch | Probiotic supplements with Lactobacillus acidophilus ZT-L1, Bifidobacterium bifidum ZT-B1, L. reuteri ZT-Lre, and L. fermentum ZT-L3 (8 × 109 CFU/d in total) | 1 capsule/d | 12 weeks | ↓ BUN (mg/dL) (§) | Cb: 22.2 ± 9.9 Ce: 22.6 ± 12.1 CΔ: 0.4 ± 7.7 | Ib: 23.5 ± 10.6 Ie: 20.0 ± 8.3 IΔ: −3.5 ± 5.8 | CΔ vs. IΔ p = 0.03 (§) | [52] |
↓ Serum Cr (mg/dL) (§) | Cb: 1.3 ± 0.5 Ce: 1.4 ± 0.5 CΔ: 0.1 ± 0.2 | Ib: 1.5 ± 0.5 Ie: 1.3 ± 0.5 IΔ: −0.2 ± 0.3 | CΔ vs. IΔ p = 0.001 (§) | |||||||||
↑ eGFR (mL/min) (§) | Cb: 68.4 ± 25.1 Ce: 65.1 ± 24.1 CΔ: −3.2 ± 6.4 | Ib: 58.4 ± 22.8 Ie: 66.7 ± 25.8 IΔ: 8.3 ± 17.3 | CΔ vs. IΔ p = 0.001 (§) | |||||||||
Urine Protein (mg/day) | Cb: 1330.0 ± 637 Ce: 1331.3 ± 640 CΔ: 0.13 ± 33.5 | Ib: 1261.7 ± 698.3 Ie: 1247.3 ± 713.4 IΔ: −14.3 ± 40.1 | CΔ vs. IΔ p = 0.10 (No significant effect) | |||||||||
Probiotic (MS) | R, DB, PC, CT (Iran) | Diabetic hemodialysis n = 30 (20M/10F) (27/30 = T2D) (3/30 = T1D) 59.4 ± 16.0 27.0 ± 6.4 | Diabetic hemodialysis n = 30 (20M/10F) (27/30 = T2D) (3/30 = T1D) 54.0 ± 16.0 25.5 ± 5.6 | ‘Placebo’ | Probiotic capsule containing Lactobacillus acidophilus, L. casei, and Bifidobacterium bifidum (2 × 109 CFU/g each) | 1 capsule/d | 12 weeks | eGFR (ml·min−1 (1.73 m2)−1) | Cb: 2.22 ± 0.86 Ce: 2.25 ± 0.93 CΔ: 0.02 ± 0.20 (Cb vs. Ce p = 0.46) | Ib: 2.49 ± 1.15 Ie: 2.54 ± 1.16 IΔ: 0.04 ± 0.18 (Ib vs. Ie p = 0.23) | CΔ vs. IΔ p = 0.77; adjusted p = 0.74 (No significant effect) | [53] |
Serum Cr (mg/dL) | Cb: 7.8 ± 3.0 Ce: 7.7 ± 2.9 CΔ: −0.1 ± 0.8 (Cb vs. Ce p = 0.48) | Ib: 7.4 ± 3.1 Ie: 7.2 ± 2.6 IΔ: −0.2 ± 1.2 (Ib vs. Ie p = 0.39) | CΔ vs. IΔ p = 0.73; adjusted p = 0.33 (No significant effect) | |||||||||
BUN (mg/dL) | Cb: 53.6 ± 19.5 Ce: 52.3 ± 12.7 CΔ: −1.3 ± 16.1 (Cb vs. Ce p = 0.65) | Ib: 64.9 ± 29.5 Ie: 63.9 ± 26.0 IΔ: −1.0 ± 32.6 (Ib vs. Ie p = 0.85) | CΔ vs. IΔ p = 0.96; adjusted p = 0.17 (No significant effect) | |||||||||
Serum Albumin (g/dL) | Cb: 4.0 ± 0.4 Ce: 4.1 ± 0.4 CΔ: 0.1 ± 0.4 (Cb vs. Ce p = 0.38) | Ib: 4.2 ± 0.4 Ie: 4.3 ± 0.4 IΔ: 0.1 ± 0.3 (Ib vs. Ie p = 0.45) | CΔ vs. IΔ p = 0.84; adjusted p = 0.48 (No significant effect) | |||||||||
Serum Sodium (mmol/L) | Cb: 137.1 ± 4.2 Ce: 138.1 ± 2.9 CΔ: 1.0 ± 3.8 (Cb vs. Ce p = 0.10) | Ib: 135.9 ± 3.3 Ie: 136.2 ± 3.1 IΔ: 0.3 ± 3.8 (Ib vs. Ie p = 0.63) | CΔ vs. IΔ p = 0.51; adjusted p = 0.07 (No significant effect) | |||||||||
Serum Potassium (mmol/L) | Cb: 4.6 ± 0.7 Ce: 4.4 ± 0.4 CΔ: −0.1 ± 0.6 (Cb vs. Ce p = 0.10) | Ib: 4.8 ± 0.6 Ie: 4.7 ± 0.7 IΔ: −0.1 ± 0.6 (Ib vs. Ie p = 0.19) | CΔ vs. IΔ p = 0.87; adjusted p = 0.18 (No significant effect) | |||||||||
Probiotic (MS) | SB, PC, CT (Egypt) | Diabetic ESRD hemodialysis n = 30 (18M/12F) 50.9 ± 16.9 BMI NS | Diabetic ESRD hemodialysis n = 30 (12M/18F) 57.7 ± 11.4 BMI NS | Placebo capsules, ESA, and anti-diabetic agents | Capsules containing study agent (5 × 106 of Lactobacillus delbrueckii and L. fermentum), ESA, and antidiabetic agents | 1 capsule/d | 12 weeks | Serum Albumin (g/dL) | Cb: 3.5 (IQR: 3.1−4.0) Ce: 3.5 (IQR: 3.0–3.6) (Cb vs. Ce p = 0.116) | Ib: 3.4 (IQR: 3.2–3.5) Ie: 3.5 (IQR: 3.1–3.8) (Ib vs. Ie p = 0.039) (§) | Effect NS | [40] |
Prebiotic | DB, PC (Iran) | T2D-Overwight n = 22 (22F) 48.61 ± 9.16 29.98 ± 4.01 | T2D-Overwight n = 27 (27F) 48.07 ± 8.70 31.43 ± 3.50 | Maltodextrin | Oligofructose-enriched chicory inulin | 5 × 2 g/d | 2 months | Serum Cr (mg/dL) | Cb: 0.78 ± 0.09 Ce: 0.82 ± 0.14 (Cb vs. Ce p = 0.16) | Ib: 0.77 ± 0.11 Ie: 0.79 ± 0.10 (Ib vs. Ie p = 0.47) | Ce vs. Ie p = 0.44 (No significant effect) | [41] |
Serum Phosphorous (mg/dL) | Cb: 4.23 ± 0.45 Ce: 4.00 ± 0.45 (Cb vs. Ce p = 0.013) | Ib: 3.96 ± 0.48 Ie: 3.96 ± 0.56 (Ib vs. Ie p = 0.97) | Ce vs. Ie p = 0.80 (No significant effect) | |||||||||
eGFR (ml·min−1 (1.73 m2)−1) | Cb: 85.30 ± 13.45 Ce: 82.05 ± 16.06 (Cb vs. Ce p = 0.28) | Ib: 86.34 ± 13.96 Ie: 84.30 ± 13.57 (Ib vs. Ie p = 0.44) | Ce vs. Ie p = 0.65 (No significant effect) | |||||||||
Prebiotic | R, PC, TB, CT (Iran) | T2D-Overwight n = 33 (33F) 48.6 ± 7.9 32.0 ± 3.9 | T2D-Overwight n = 32 (32F) 49.5 ± 8.0 31.5 ± 4.5 | Maltodextrin | Resistant dextrin supplement (NUTRIOSE®06) | 5 × 2 g/d | 8 weeks | Uric Acid (mg/dL) | Cb: 5.40 ± 0.61 Ce: 5.50 ± 0.33 CΔ MD: 0.10 (95% CI: −0.80; 1.12) (Cb vs. Ce p = 0.28) | Ib: 4.80 ± 0.40 Ie: 5.60 ± 0.20 IΔ MD: 1.85 (95% CI: 0.91; 1.24) (Ib vs. Ie p < 0.05) (§) | CΔ vs. IΔ MD: 0.10 (95% CI: −1.55; 0.75) (No significant effect) | [42] |
Prebiotic | R, DB, PC (Japan) | n = 25 (17M/8F) 54 ± 12 27.2 ± 4.6 | n = 27 (21M/6F) 55 ± 11 27.9 ± 3.6 | Maltodextrin syrup | GOS syrup (Oligomate55N) | 10 g/d | 4 weeks | BUN (mg/dL) | Cb: 14.0 ± 4.0 Ce: 13.0 ± 3.0 (Cb vs. Ce p > 0.05) | Ib: 15.0 ± 5.0 Ie: 15.0 ± 5.0 (Ib vs. Ie p > 0.05) | No significant effect | [43] |
Serum Cr (mg/dL) | Cb: 0.7 ± 0.2 Ce: 0.8 ± 0.2 (Cb vs. Ce p < 0.05) (§) | Ib: 0.9 ± 0.5 Ie: 0.9 ± 0.4 (Ib vs. Ie p > 0.05) | No significant effect | |||||||||
eGFR (mL/min) | Cb: 85.1 ± 21.3 Ce: 79.9 ± 18.7 (Cb vs. Ce p < 0.05) (§) | Ib: 75.1 ± 24.4 Ie: 71.2 ±2 1.6 (Ib vs. Ie p < 0.05) (§) | Effect NS | |||||||||
Synbiotic (SS) | R, DB, CC, CT (Iran) | n = 62 (19M/43F) 53.1 ± 8.7 29.90 ± 5.18 | n = 62 (19M/43F) 53.1 ± 8.7 29.60 ± 4.53 | 0.38 g isomalt, 0.36 g sorbitol and 0.05 g stevia per 1g | Heat-resistant Lactobacillus sporogenes (1 × 107 CFU), 0.04 g inulin, 0.38 g isomalt, 0.36 g sorbitol and 0.05 g stevia per gram | 9 × 3 g/d | 6 × 2 weeks | ↑ Uric acid (mg/dL) (§) | Cb: 5.5 ± 0.3 Ce: 5.4 ± 0.2 CΔ: −0.1 ± 0.3 | Ib: 4.9 ± 0.2 Ie: 5.6 ± 0.2 IΔ: 0.7 ± 0.2 | CΔ vs. IΔ p = 0.03 (§) | [44] ψ |
Synbiotic (MS) | SC, R, DB, PC (Iran) | n = 35 (19M/16F) 58.63 ± 8.06 27.30 ± 3.81 | n = 35 (23M/12F) 58.71 ± 8.20 28.13 ± 3.78 | Capsules containing row starch, B group vitamins (1 mg), lactose (0.5 mg), malt-dextrin, magnesium saturate and talc | Capsules containing Lactobacillus family, Bifidobacterium family, Streptococcus thermophilus, FOS, B group vitamins (1 mg), lactose (0.5 mg), maltodextrin, magnesium saturate and talc | 1 × 500 mg capsule/d | 9 weeks | Urea (mg/dL) | Cb: 36.80 ± 14.79 Ce: 37.94 ± 14.57 CΔ: −1.14 ± 7.30 (Cb vs. Ce p = 0.36) | Ib: 31.20 ± 7.67 Ie: 33.25 ± 7.61 IΔ: −2.05 ± 7.31 (Ib vs. Ie p = 0.10) | Ce vs. Ie p = 0.09 CΔ vs. IΔ p = 0.60 (No significant effect) | [45] |
Serum Cr (mg/dL) | Cb: 1.05 ± 0.22 Ce: 1.03 ± 0.24 CΔ: 0.02 ± 0.11 (Cb vs. Ce p = 0.22) | Ib: 1.04 ± 0.26 Ie: 1.05 ± 0.26 IΔ: −0.00 ± 0.09 (Ib vs. Ie p = 0.82) | Ce vs. Ie p = 0.73 CΔ vs. IΔ p = 0.73 (No significant effect) | |||||||||
↓ Urine Alb/Cr (mg/g) (§) | Cb: 62.77 ± 59.6 Ce: 81.09 ± 81.58 CΔ: 18.31 ± 46.78 (Cb vs. Ce p = 0.027) (§) | Ib: 45.39 ± 38.85 Ie: 34.94 ± 13.1 IΔ: −10.44 ± 35.26 (Ib vs. Ie p = 0.089) | Ce vs. Ie p = 0.00 (§) CΔ vs. IΔ p < 0.0001 (§) |
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Paul, P.; Kaul, R.; Chaari, A. Renal Health Improvement in Diabetes through Microbiome Modulation of the Gut–Kidney Axis with Biotics: A Systematic and Narrative Review of Randomized Controlled Trials. Int. J. Mol. Sci. 2022, 23, 14838. https://doi.org/10.3390/ijms232314838
Paul P, Kaul R, Chaari A. Renal Health Improvement in Diabetes through Microbiome Modulation of the Gut–Kidney Axis with Biotics: A Systematic and Narrative Review of Randomized Controlled Trials. International Journal of Molecular Sciences. 2022; 23(23):14838. https://doi.org/10.3390/ijms232314838
Chicago/Turabian StylePaul, Pradipta, Ridhima Kaul, and Ali Chaari. 2022. "Renal Health Improvement in Diabetes through Microbiome Modulation of the Gut–Kidney Axis with Biotics: A Systematic and Narrative Review of Randomized Controlled Trials" International Journal of Molecular Sciences 23, no. 23: 14838. https://doi.org/10.3390/ijms232314838