Clinical Nutrition Research

The Korean Society of Clinical Nutrition (한국임상영양학회)
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The Effect of Synbiotic Supplementation on Bone Complications, Anemia, and Gastrointestinal Function in Hemodialysis Patients: A Double-Blind Randomized Clinical Trial

  • Yasaman Azamian (Student Research Committee, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences) ;
  • Hadi Abdollahzad (Department of Nutrition, School of Medicine, Urmia University of Medical Sciences) ;
  • Shahab Rezaeian (Infectious Diseases Research Center, Health Institute, Kermanshah University of Medical Sciences) ;
  • Mohammad Hossein Rouhani (Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences) ;
  • Mohammad Hossein Fatehi (Department of Internal Medicine, Farabi Hospital, Isfahan University of Medical Sciences)
  • Received : 2024.07.23
  • Accepted : 2024.09.12
  • Published : 2024.10.30
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Abstract

Probiotics affect biomarkers indicative of bone formation, such as alkaline phosphatase (ALP), calcium status, bone mineralization, bone turnover markers and metabolism. This study aims to investigate the effects of synbiotic on gastrointestinal (GI) disorder, bone complications and anemia in hemodialysis (HD) patients. In this randomized, double-blind, placebo-controlled clinical trial study, HD patients received 2 symbiotic (n = 19) or placebo (n = 17) capsules daily for 12 weeks. GI function, serum levels of bone-specific biomarkers, and serum levels of anemia-specific biomarkers were assessed at the beginning and the end of study. GI function was assessed with gastrointestinal symptom rating scale questionnaire. The data were analyzed using SPSS. At the end of this study, parathyroid hormone levels decreased significantly in the synbiotic group (p = 0.039); however, in comparison to placebo group, the difference was not significant. Decrease of ALP levels in the synbiotic group were not statistically significant. However, a significant difference was seen between the 2 groups at the end of intervention (p = 0.037). Improvement in GI symptoms was observed in both groups, but the reduction rate was higher in the synbiotic group. Additionally, at the end of the study, a significant difference between the 2 groups was observed (p < 0.05). No statistically significant difference was observed in the levels of other factors within each group and between the 2 groups (p > 0.05). Symbiotic supplements after 12 weeks led to an improvement in GI function and ALP levels in HD patients. Further investigation into bone-mineral disorders in HD patients is necessary.

Keywords

Acknowledgement

We would like to express our utmost gratitude and appreciation to the research committee of Kermanshah University of Medical Sciences. Also, we are grateful for all the assistance provided by the staff of the dialysis department at Farabi Hospital in Isfahan.

References

  1. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, et al. Chronic kidney disease: global dimension and perspectives. Lancet 2013;382:260-72.
  2. Sesso RC, Lopes AA, Thome FS, Lugon JR, Watanabe Y, et al. Report of the Brazilian chronic dialysis census 2012. J Bras Nefrol 2014;36:48-53.
  3. Gordon PL, Sakkas GK, Doyle JW, Shubert T, Johansen KL. Relationship between vitamin D and muscle size and strength in patients on hemodialysis. J Ren Nutr 2007;17:397-407.
  4. Oste L, Bervoets AR, Behets GJ, Dams G, Marijnissen RL, et al. Time-evolution and reversibility of strontium-induced osteomalacia in chronic renal failure rats. Kidney Int 2005;67:920-30.
  5. Magnusson P, Sharp CA, Magnusson M, Risteli J, Davie MW, et al. Effect of chronic renal failure on bone turnover and bone alkaline phosphatase isoforms. Kidney Int 2001;60:257-65. 
  6. Wong J, Piceno YM, DeSantis TZ, Pahl M, Andersen GL, et al. Expansion of urease- and uricase-containing, indole- and p-cresol-forming and contraction of short-chain fatty acid-producing intestinal microbiota in ESRD. Am J Nephrol 2014;39:230-7.
  7. Parvaneh K, Jamaluddin R, Karimi G, Erfani R. Effect of probiotics supplementation on bone mineral content and bone mass density. Sci World J 2014;2014:595962.
  8. Harahap IA, Suliburska J. Probiotics and isoflavones as a promising therapeutic for calcium status and bone health: a narrative review. Foods 2021;10:2685.
  9. Zhao F, Guo Z, Kwok LY, Zhao Z, Wang K, et al. Bifidobacterium lactis Probio-M8 improves bone metabolism in patients with postmenopausal osteoporosis, possibly by modulating the gut microbiota. Eur J Nutr 2023;62:965-76.
  10. Harahap IA, Moszak M, Czlapka-Matyasik M, Skrypnik K, Bogdanski P, et al. Effects of daily probiotic supplementation with Lactobacillus acidophilus on calcium status, bone metabolism biomarkers, and bone mineral density in postmenopausal women: a controlled and randomized clinical study. Front Nutr 2024;11:1401920.
  11. Vanitchanont M, Vallibhakara SA, Sophonsritsuk A, Vallibhakara O. Effects of multispecies probiotic supplementation on serum bone turnover markers in postmenopausal women with osteopenia: a randomized, double-blind, placebo-controlled trial. Nutrients 2024;16:461.
  12. Yacoub R, Nugent M, Cai W, Nadkarni GN, Chaves LD, et al. Advanced glycation end products dietary restriction effects on bacterial gut microbiota in peritoneal dialysis patients; a randomized open label controlled trial. PLoS One 2017;12:e0184789.
  13. Azamian Y, Abdollahzad H, Rezaeian S, Rouhani MH, Fatehi MH. The effect of synbiotic supplementation on plasma levels of advanced glycation end products and cardiovascular risk factors in hemodialysis patients: a double-blind clinical trial. Food Sci Nutr 2024;12:6864-72.
  14. Revicki DA, Wood M, Wiklund I, Crawley J. Reliability and validity of the gastrointestinal symptom rating scale in patients with gastroesophageal reflux disease. Qual Life Res 1998;7:75-83.
  15. Vasheghani-Farahani A, Tahmasbi M, Asheri H, Ashraf H, Nedjat S, et al. The Persian, last 7-day, long form of the international physical activity questionnaire: translation and validation study. Asian J Sports Med 2011;2:106-16.
  16. Simeoni M, Citraro ML, Cerantonio A, Deodato F, Provenzano M, et al. An open-label, randomized, placebo-controlled study on the effectiveness of a novel probiotics administration protocol (ProbiotiCKD) in patients with mild renal insufficiency (stage 3a of CKD). Eur J Nutr 2019;58:2145-56.
  17. Behrouz V, Aryaeian N, Zahedi MJ, Jazayeri S. Effects of probiotic and prebiotic supplementation on metabolic parameters, liver aminotransferases, and systemic inflammation in nonalcoholic fatty liver disease: a randomized clinical trial. J Food Sci 2020;85:3611-7.
  18. Mirzaeian S, Saraf-Bank S, Entezari MH, Hekmatdoost A, Feizi A, et al. Effects of synbiotic supplementation on microbiota-derived protein-bound uremic toxins, systemic inflammation, and biochemical parameters in patients on hemodialysis: a double-blind, placebo-controlled, randomized clinical trial. Nutrition 2020;73:110713.
  19. Massy ZA, Drueke TB. Gut microbiota orchestrates PTH action in bone: role of butyrate and T cells. Kidney Int 2020;98:269-72.
  20. Li JY, Yu M, Pal S, Tyagi AM, Dar H, et al. Parathyroid hormone-dependent bone formation requires butyrate production by intestinal microbiota. J Clin Invest 2020;130:1767-81.
  21. Michalickova D, Kotur-Stevuljevic J, Miljkovic M, Dikic N, Kostic-Vucicevic M, et al. Effects of probiotic supplementation on selected parameters of blood prooxidant-antioxidant balance in elite athletes: a double-blind randomized placebo-controlled study. J Hum Kinet 2018;64:111-22.
  22. Zhu L, Niu J, Tang XC, Shan LH, Xiao L, et al. The effects of probiotic Lactobacillus rhamnosus GG on fecal flora and serum markers of renal injury in mice with chronic kidney disease. Front Biosci (Landmark Ed) 2023;28:226.
  23. Kooshki A, Akbarzadeh R, Amin B, Tofighiyan T, Foroumandi E. Synbiotic supplement for treatment of iron deficiency anaemia in haemodialysis patients: a randomized controlled trial. Nephrology (Carlton) 2023;28:234-9.
  24. Skrypnik K, Bogdanski P, Sobieska M, Schmidt M, Suliburska J. Influence of multistrain probiotic and iron supplementation on iron status in rats. J Trace Elem Med Biol 2021;68:126849.
  25. Zhou JS, Rutherfurd KJ, Gill HS. Inability of probiotic bacterial strains Lactobacillus rhamnosus HN001 and Bifidobacterium lactis HN019 to induce human platelet aggregation in vitro. J Food Prot 2005;68:2459-64. 
  26. Mitrovic M, Stankovic-Popovic V, Tolinacki M, Golic N, Sokovic Bajic S, et al. The impact of synbiotic treatment on the levels of gut-derived uremic toxins, inflammation, and gut microbiome of chronic kidney disease patients-a randomized trial. J Ren Nutr 2023;33:278-88.
  27. Zhang WX, Shi LB, Zhou MS, Wu J, Shi HY. Efficacy of probiotics, prebiotics and synbiotics in irritable bowel syndrome: a systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials. J Med Microbiol 2023;72:001758.
  28. Takahashi N, Kojima T, Ogawa H, Ishiguro N. Correlation between parathyroid hormone, bone alkaline phosphatase and N-telopeptide of type 1 collagen in diabetic and non-diabetic haemodialysis patients. Nephrology (Carlton) 2007;12:539-45.
  29. Inaba M, Nishizawa Y, Mita K, Kumeda Y, Emoto M, et al. Poor glycemic control impairs the response of biochemical parameters of bone formation and resorption to exogenous 1,25-dihydroxyvitamin D3 in patients with type 2 diabetes. Osteoporos Int 1999;9:525-31.
  30. Farhadi A, Fields J, Banan A, Keshavarzian A. Reactive oxygen species: are they involved in the pathogenesis of GERD, Barrett's esophagus, and the latter's progression toward esophageal cancer? Am J Gastroenterol 2002;97:22-6.