The effect of probiotic supplementation on systemic inflammation in dialysis patients

BACKGROUND: Emerging evidence suggests that intestinal dysbiosis contributes to systemic inflammation and cardiovascular diseases in dialysis patients. The purpose of this study was to evaluate the effects of probiotic supplementation on various inflammatory parameters in hemodialysis (HD) patients. METHODS: Twenty-two patients with maintenance HD were enrolled. These patients were treated twice a day with 2.0 ×10(10) colony forming units of a combination of Bifidobacterium bifidum BGN4 and Bifidobacterium longum BORI for 3 months. The microbiome and fecal short-chain fatty acids (SCFAs) were analyzed. The percentages of CD14(+) CD16(+) proinflammatory monocytes and CD4(+) CD25(+) regulatory T-cells (Tregs) before and after probiotic supplementation were determined by flow cytometry. Serum levels of calprotectin and cytokine responses upon lipopolysaccharide (LPS) challenge were compared before and after probiotic supplementation. RESULTS: Fecal SCFAs increased significantly after probiotic supplementation. Serum levels of calprotectin and interleukin 6 upon LPS stimulation significantly decreased. The anti-inflammatory effects of probiotics were associated with a significant increase in the percentage of CD4(+) CD25(+) Tregs (3.5% vs. 8.6%, p < 0.05) and also with a decrease of CD14(+) CD16(+) proinflammatory monocytes (310/mm(2) vs. 194/mm(2), p < 0.05). CONCLUSION: Probiotic supplementation reduced systemic inflammatory responses in HD patients and this effect was associated with an increase in Tregs and a decrease in proinflammatory monocytes. Hence, targeting intestinal dysbiosis might be a novel strategy for decreasing inflammation and cardiovascular risks in HD patients.