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. 2018 May 9;13(10):1598–1604. doi: 10.2215/CJN.12691117

Table 2.

Therapies that modify the human intestinal microbiome and bacterial byproduct metabolism in kidney disease

Study Design Intervention Subjects Primary Outcome Secondary Outcomes Ref.
Adsorbent
 RCT, 1:1 active versus placebo, 189-wk EPPIC1, 170-wk EPPIC2 AST-120 CKD 4, n=2035 No change in time to kidney disease progressiona No change in time to kidney disease progression,a including death 40
Synbiotic
 RCT, 2:1 active versus placebo, 30 d Probinul Neutra After kidney transplant, n=36 ↓ p-Cresol No change in kidney function, glycemia, lipids, albumin 41
 RCT, active versus placebo, 6-wk crossover, 4-wk washout Synbiotic CKD 3–4, n=37 No change in indoxyl sulfate ↓ p-Cresol; significant change in microbiome; ↑ albuminuria; no change in eGFR, urinary kidney injury molecule-1, serum inflammatory, or oxidative stress biomarkers 42
 RCT, 1:1 active versus placebo, 30 d Probinul Neutra CKD 3–4, n=30 ↓ p-Cresol No change in gastrointestinal symptoms 43
 RCT, 1:1 active versus placebo, 2 mo Synbiotic ESKD, n=18 ↑ Stool bifidobacterial counts ↓ Gastrointestinal symptoms 44
 RCT, 1:1 active versus placebo, 2 mo Synbiotic ESKD, n=44 ↓ Gastrointestinal symptoms ↓ Markers of malnutrition and serum CRP and TNF-α levels (NS) 45
Prebiotic
 RCT, active versus placebo, 6-wk crossover, 4-wk washout Arabinoxylan oligosaccharides CKD 3–4, n=39 ↓ TMAO; no change in urea, p-cresyl sulfate, p-cresyl glucuronide, indoxyl sulfate, phenylacetylglutamine No change in urinary excretion of urea, p-cresyl sulfate, p-cresyl glucuronide, indoxyl sulfate, phenylacetylglutamine, TMAO; no change in insulin resistance 46
Sevelamer
 RCT, 1:1 active versus placebo, 3 mo Sevelamer CKD 3–5 (predialysis), n=69 ↓ p-Cresol ↓ LDL and serum phosphorus 8
Dietary fiber
 Single blinding, 12 wk Dietary fiber CKD 3, n=13 ↓ p-Cresol ↑ Stool frequency; no change in quality of life 47
 RCT, 1:1 active versus placebo, 6 wk Dietary fiber ESKD, n=40 ↓ Indoxyl sulfate; ↓ p-cresol (NS) No change in predialysis weight, BUN, serum albumin, prealbumin, CRP, phosphorus, or KDQOL-36 48
Antibiotics
 Observational, 28 d Single 250-mg oral dose of vancomycin ESKD, n=10 ↓ Indoxyl sulfate; ↓ p-cresyl sulfate Decrease in gut microbiome diversity 9

RCT, randomized, controlled trial; EPPIC1, Evaluating Prevention of Progression of CKD 1; EPPIC2, Evaluating Prevention of Progression of CKD 2; CRP, C-reactive protein; NS, nonsignificant; TMAO, trimethylamine-N-oxide; KDQOL-36, Kidney Disease Quality of Life 36 instrument.

a

Composite of dialysis initiation, kidney transplant, and serum creatinine doubling.