Gut microbiome-targeted therapeutics for chronic kidney disease: comparative efficacy of probiotic and microbial preparations.

BACKGROUND

Probiotics supplements may be a solution to improve and delay chronic kidney disease (CKD), but their anti-inflammatory and other effects remain unclear. Our study conducted network meta-analysis (NMA) to appraise the efficacy of supplementary probiotic and microbial preparations for CKD patients.

METHODS

Searches for eligible trials were performed until January 30, 2025. The relative efficacy of various interventions was assessed using surface under the cumulative ranking (SUCRA).

RESULTS

This NMA included 53 studies and evaluated 4 aspects of the outcomes: renal markers and uremic toxins, glucolipid metabolism, inflammation and oxidative stress indices, and dietary intake. Multi-combination of three probiotics (Mix1) and four or more probiotics (Mix2) intervention were associated with significantly higher efficacy. For example, Mix2 intervention was the highest effecacy in reducing creatinine (SUCRA: 79.1%) and glucose (SUCRA: 97.1%). Moreover, Mix1 yielded the best ranking in decreasing uric acid (SUCRA: 82.5%), fasting blood sugar (FBS) (SUCRA: 92.0%), and malondialdehyde (MDA) (SUCRA: 78.7%).

CONCLUSION

Multi-combination of three or more probiotics may be the best choice for improving renal function, glucolipid metabolism, inflammation, oxidative stress, and dietary intake in CKD patients.