Table 2.

Summary of clinical trials on probiotics treatment used in patients with maintenance hemodialysis and peritoneal dialysis.

Reference	Study Population	Country/ Region	Type of Study	Sample Size	Endpoint Observed	Probiotic Type and Intervention Duration	Remarks
Chih-Yu Yang et al. [36]	Hemodialysis patients	Taiwan	A single-centre, double-blind, placebo-controlled, randomized trial	Animal model and 40 CKD patients and 22 healthy controls	The plasma levels of indoxyl sulfate and p-cresol sulfate in different groups, the relationship between gut microbiota, fecal indole content, and blood indoxyl sulfate level	Synbiotic and probiotics combination of Lactobacillus sp., Bifidobacterium sp., and Streptococcus sp. 5 weeks	Gut dysbiosis and renal function impairment could be ameliorated by synbiotic and probiotics treatment
Daniela Viramontes-Horner et al. [45]	Hemodialysis patients	Mexico	A double-blinded, placebo-controlled, randomized, clinical trial	22	Gastrointestinal symptoms (GISs) severity between intervention with control group	A mix of probiotics (Lactobacillus acidophilus NCFM and Bifidobacterium lactis Bi-07) 2 months	Administration of a symbiotic and probiotics gel is a safe and simple way to improve common GIS in dialysis patients
Farzad Eidi et al. [46]	Hemodialysis patients	Iran	A randomized controlled double-blind clinical trial	42	Uremic toxins between groups before and after Lactobacillus Rhamnosus use: total phenol and p-cresol	Lactobacillus Rhamnosus 4 weeks	Probiotics in hemodialysis patients can decrease serum phenolic uremic toxins.
Jose Cruz-Mora et al. [47]	Hemodialysis patients	Mexico	A randomized, double-blinded, placebo-controlled clinical trial	18	Bifidobacterial and lactobacilli counts, gastro intestinal symptoms scores in two groups	Probiotics (Lactobacillus acidophilus and Bifidobacterium bifidum) 2 months	Short-term symbiotic treatment in patients with ESRD can lead to the increase in Bifidobacterium counts, maintaining the intestinal microbial balance
Natalia A. Borges et al. [48]	Hemodialysis patients	Brazil	A randomized, double-blind, placebo-controlled study	46	Inflammatory markers (C-reactive protein and interleukin-6), uremic toxins plasma levels (indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid), fecal pH, and gut microbiota profile	Streptococcus thermophilus, Lactobacillus acidophilus and Bifidobacteria longum 3 months	Probiotic supplementation failed to reduce uremic toxins and inflammatory markers
Alireza Soleimani et al. [49]	Hemodialysis patients	Iran	A parallel randomized double-blind placebo-controlled clinical trial	55	Fasting plasma glucose, serum insulin, homeostasis model of assessment-estimated insulin resistance, homeostasis model of assessment-estimated beta-cell function and HbA1c, and quantitative insulin sensitivity check index	Probiotics Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum 12 weeks	Probiotic supplementation for 12 weeks among diabetic hemodialysis patients had beneficial effects on parameters of glucose homeostasis, and some biomarkers of inflammation and oxidative stress
Ranganathan Natarajan et al. [12]	Hemodialysis patients	USA	A randomized, double-blind, placebo-controlled crossover study	22	Decline in WBC count and reductions in levels of C-reactive protein, and total indoxyl glucuronide, and QOL	Probiotic formulation—30 billion CFU of S; Thermophilus KB 19, L. acidophilus KB 27, and B. longum KB 31 6 months	Renadyl (strain-specific probiotic formulation) appeared to be safe to administer to ESRD patients on hemodialysis with stability in QOL assessment
Eunho Choi et al. [40]	Hemodialysis patients	Korea	A randomized, double-blind, placebo-controlled study	22	Various inflammatory parameters in hemodialysis (HD) patients	Bifidobacterium bifidum BGN4 and Bifidobacterium longum BORI 3 months	Probiotic supplementation reduced systemic inflammatory responses in HD patients with an increase in Tregs and a decrease in proinflammatory monocytes
Zahra Shariaty et al. [50]	Hemodialysis patients	Iran	A randomized parallel clinical trial	36	Hemoglobin (Hb) and serum C-reactive protein before and after intervention in probiotic and placebo groups	Lactobacillus acidophilus, Bifidobacterium and Streptococcus thermophilus 3 months	Probiotic supplementation decreased Hb fluctuations in hemodialysis patients but did not result in a significant increase in Hb levels.
Yangbin Pan et al. [51]	Peritoneal dialysis patients	China	A randomized controlled trial	116	High-sensitivity C-reactive protein and interleukin-6, serum albumin levels, upper arm circumference, and triceps skinfold thickness, scores on the SF-36 in different groups	Bifidobacterium longum, Lactobacillus bulgaricus, and Streptococcus thermophilus 2 months	Malnutrition and health-related quality of life partially improved after probiotic supplementation in patients undergoing PD
Shuiqing He et al. [52]	Peritoneal dialysis patients	China	A randomized, double-blind, placebo controlled crossover trial	16	Serum uric acid (UA) levels, fecal UA degradation capability, fecal metagenomic analysis to assess microbial composition and function	Inulin-type prebiotics was composed of a mixture of inulin and oligofructose 12 weeks	Inulin-type prebiotics can reduce serum UA levels in renal failure patients, and this urate-lowering effect could possibly be attributed to intestinal microbial degradation of UA
I.K. Wang et al. [34]	Peritoneal dialysis patients	Taiwan	A randomized, double-blind, placebo-controlled trial	39	The change in serum TNF-α, interferon gamma, IL-5, IL-6, IL-10, IL-17, and endotoxin levels before and six months after intervention	Bifobacterium bifidum A218, Bifidobacterium catenulatum A302, Bifidobacterium longum A101, and Lactobacillus plantarum A87 6 months	Probiotics could significantly reduce the serum levels of endotoxin, pro-inflammatory cytokines (TNF-α and IL-6), IL-5, increase the serum levels of anti-inflammatory cytokine (IL-10), and preserve residual renal function in PD patients.