Bruna Guida1,2, Mauro Cataldi2,3, Andrea Memoli2,4, Rossella Trio2, Martina di Maro1,2, Lucia Grumetto5, Ivana Capuano2,4, Stefano Federico2,4, Antonio Pisani2,4, Massimo Sabbatini2,4. 1. a Department of Clinical Medicine and Surgery, Physiology Nutrition Unit , Federico II University of Naples , Naples , Italy. 2. b Federico II University Hospital , Naples , Italy. 3. c Department of Neuroscience, Reproductive Sciences and Dentistry, Division of Pharmacology , Federico II University of Naples , Naples , Italy. 4. d Department of Public Health, Nephrology Section , Federico II University of Naples , Naples , Italy. 5. e Department of Pharmaceutical and Toxicological Chemistry , Federico II University of Naples , Naples , Italy.
Abstract
OBJECTIVE: We evaluated whether a short-term course with synbiotics may lower plasma p-Cresol concentrations in kidney transplant patients (KTRs) who accumulate this uremic toxin both because of increased production by their dysbiotic gut microbiome and because of reduced elimination by the transplanted kidneys. METHODS:Thirty-six KTRs (29 males, mean age 49.6 ± 9.1 years) with transplant vintage > 12 months, stable graft function, and no episode of acute rejection or infection in the last 3 months were enrolled in this single-center, parallel-group, double-blinded, randomized (2:1 synbiotic to placebo) study. Synbiotic (Probinul Neutro, CadiGroup, Rome, Italy) or placebo was taken at home for 30 days, as 5 g powder packets dissolved in water three times a day far from meals. The main outcome measure was the decrease in total plasma p-Cresol measured by high-performance liquid chromatography at baseline and after 15 and 30 days of placebo or synbiotic treatment. RESULTS: After 15 and 30 days of treatment, plasma p-Cresol decreased by 40% and 33% from baseline (both p < 0.05), respectively, in the synbiotic group, whereas it remained stable in the placebo group. After 30 days of treatment, no significant change was observed in either group in renal function, glycemia, plasma lipids, or albumin concentration. Treatment was well tolerated and did not induce any change in stool characteristics. CONCLUSION: The results of this pilot study suggest that treatment with synbiotics may be effective to lower plasma p-Cresol concentrations in KTRs. Prospective larger scale, longer term studies are needed to establish whether cardiovascular prognosis could also be improved with this nutritional intervention.
RCT Entities:
OBJECTIVE: We evaluated whether a short-term course with synbiotics may lower plasma p-Cresol concentrations in kidney transplant patients (KTRs) who accumulate this uremic toxin both because of increased production by their dysbiotic gut microbiome and because of reduced elimination by the transplanted kidneys. METHODS: Thirty-six KTRs (29 males, mean age 49.6 ± 9.1 years) with transplant vintage > 12 months, stable graft function, and no episode of acute rejection or infection in the last 3 months were enrolled in this single-center, parallel-group, double-blinded, randomized (2:1 synbiotic to placebo) study. Synbiotic (Probinul Neutro, CadiGroup, Rome, Italy) or placebo was taken at home for 30 days, as 5 g powder packets dissolved in water three times a day far from meals. The main outcome measure was the decrease in total plasma p-Cresol measured by high-performance liquid chromatography at baseline and after 15 and 30 days of placebo or synbiotic treatment. RESULTS: After 15 and 30 days of treatment, plasma p-Cresol decreased by 40% and 33% from baseline (both p < 0.05), respectively, in the synbiotic group, whereas it remained stable in the placebo group. After 30 days of treatment, no significant change was observed in either group in renal function, glycemia, plasma lipids, or albumin concentration. Treatment was well tolerated and did not induce any change in stool characteristics. CONCLUSION: The results of this pilot study suggest that treatment with synbiotics may be effective to lower plasma p-Cresol concentrations in KTRs. Prospective larger scale, longer term studies are needed to establish whether cardiovascular prognosis could also be improved with this nutritional intervention.
Authors: Tess E Cooper; Nicole Scholes-Robertson; Jonathan C Craig; Carmel M Hawley; Martin Howell; David W Johnson; Armando Teixeira-Pinto; Allison Jaure; Germaine Wong Journal: Cochrane Database Syst Rev Date: 2022-09-20
Authors: Cassandra Kimber; Shiqin Zhang; Cassandra Johnson; Raymond E West; Alexander J Prokopienko; Jonathan D Mahnken; Alan S Yu; Andrew N Hoofnagle; Diana Ir; Charles E Robertson; Makoto Miyazaki; Michel Chonchol; Anna Jovanovich; Bryan Kestenbaum; Daniel N Frank; Thomas D Nolin; Jason R Stubbs Journal: Kidney360 Date: 2020-11-25