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Accumulated data suggests that imbalance of the gut microbiota may contribute to chronic kidney disease (CKD). The use of probiotics and prebiotics can modulate micro-ecological environment, but their effect on kidney health remains unclear.
We performed a cross-sectional analysis of 15,2914 participants in the National Health and Nutrition Examination Surveys (NHANES) from 2005 to 2016. The relationships between of probiotic or prebiotic use with kidney functions, cardiovascular disease (CVD) and all-cause mortality, and prevalence of CKD were further evaluated using stratification analysis, logistic regression, and Cox proportional hazards models. We also investigated the correlations between probiotics/prebiotics, serum α-Klotho (an anti-aging protein) and CKD.
The use of probiotic/prebiotic showed a negative association with urine albumin-to-creatinine ratio (uACR) (p=0.027), but no association with eGFR (p=0.027) . Patients with type 2 diabetes mellitus (T2DM) who consumed probiotics/prebiotics had a significantly lower prevalence of CKD than those who did not (26.57% vs. 40.09%, p <0.001), with an odds ratio (OR) of 0.47 (95%CI 0.25-0.86, p=0.015) after adjustment for confounders. Patients with CKD who consumed probiotics/prebiotics had lower uACR level and higher serum levels of α-Klotho, compared with those who had no consumption (p<0.05, for all). The probiotics/prebiotics group also showed a significantly lower risk of all-cause mortality (HR 0.643, 95%CI 0.495-0.834, p<0.001) compared to patients with no probiotics/prebiotics use. A non-linear concentration-response relationship of serum soluble α-Klotho level with all-cause mortality were also demonstrated (P < 0.05) in CKD patients.
The use of probiotics/prebiotics was associated with lower risk of proteinuria, and reduced risk of CKD in T2DM patients. The reno-protective effects via the α-Klotho pathways warrant further investigation.