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The effect of probiotics on serum levels of cytokine and endotoxin in peritoneal dialysis patients: a randomised, double-blind, placebo-controlled trial

In: Beneficial Microbes
Authors:
I.-K. Wang Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, 2 Yue-Der Road, Taichung 404, Taiwan
Divisions of Nephrology, China Medical University Hospital, 2 Yue-Der Road, Taichung 404, Taiwan
Department of Internal Medicine, College of Medicine, China Medical University, 2 Yue-Der Road, Taichung 404, Taiwan

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Y.-Y Wu Department of Medical Laboratory Science and Biotechnology, China Medical University, 2 Yue-Der Road, Taichung 404, Taiwan

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Y.-F Yang Divisions of Nephrology, China Medical University Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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I.-W. Ting Divisions of Nephrology, China Medical University Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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C.-C. Lin Divisions of Nephrology, China Medical University Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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T.-H. Yen Division of Nephrology, Chang Gung Memorial Hospital, Taipei and Chang Gung University, 199 Tung Hwa North Road, Taipei 105, Taiwan

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J.-H. Chen Biostatistics Center and School of Public Health, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan

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C.-H. Wang Department of Pediatrics, China Medical University and Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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C.-C. Huang Divisions of Nephrology, China Medical University Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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H.-C. Lin Department of Pediatrics, China Medical University and Hospital, 2 Yue-Der Road, Taichung 404, Taiwan

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Inflammatory markers such as interleukin (IL)-6 and tumour necrosis factor-alpha (TNF-α) are elevated in dialysis patients and can predict cardiovascular events and all-cause mortality. Endotoxin is an important source and also another marker of inflammation in patients with chronic kidney disease. The aim of this study was to evaluate the impact of oral probiotics on serum levels of endotoxemia and cytokines in peritoneal dialysis (PD) patients. The decline of residual renal function, peritonitis episodes, and cardiovascular events were also recorded. From July 2011 to June 2012, a randomised, double-blind, placebo-controlled trial was conducted in PD patients. The intervention group received one capsule of probiotics containing 109 cfu Bifobacterium bifidum A218, 109 cfu Bifidobacterium catenulatum A302, 109 cfu Bifidobacterium longum A101, and 109 cfu Lactobacillus plantarum A87 daily for six months, while the placebo group received similar capsules containing maltodextrin for the same duration. Levels of serum TNF-α, interferon gamma, IL-5, IL-6, IL-10, IL-17, and endotoxin were measured before and six months after intervention. 39 patients completed the study (21 in the probiotics group and 18 in the placebo group). In patients receiving probiotics, levels of serum TNF-α, IL-5, IL-6, and endotoxin significantly decreased after six months of treatment, while levels of serum IL-10 significantly increased. In contrast, there were no significant changes in levels of serum cytokines and endotoxin in the placebo group after six months. In addition, the residual renal function was preserved in patients receiving probiotics. In conclusion, 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.

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