Multispecies Probiotic Supplementation in Chronic Kidney Disease (CKD): Insights From Indian Nephrology Experts

Chronic kidney disease (CKD) is a progressive condition leading to the accumulation of uremic toxins and systemic complications, eventually resulting in loss of kidney function. One of the major mechanisms behind the CKD complications is gut dysbiosis, a commotion in the gut micro-ecology that aggravates systemic inflammation and worsens the CKD management. Probiotics, through their ability to restore gut micro-ecology, strengthen the intestinal barrier integrity, modulate the immune system, and mitigate systemic inflammation, offer a promising add-on therapy to traditional CKD therapies. Specific probiotic strains, including <i>Streptococcus thermophilus</i>, <i>Lactobacillus acidophilus</i>, <i>Bifidobacterium longum</i>, and <i>Bacillus coagulans,</i> have demonstrated antimicrobial effects by promoting commensal bacterial growth and inhibiting pathogenic bacterial growth. Studies indicate that these probiotics reduce uremic toxin levels, such as indoxyl sulfate and p-cresyl sulfate, blood urea nitrogen, urea, and creatinine levels, enhance gut integrity, alleviate inflammation, and are beneficial for patients with CKD stages 3 to 5. While the evidence for probiotic supplementation is promising, further studies are required to establish their long-term benefits, especially in patients with immune deficiency or kidney transplants. Overall, this consensus article provides insights from Indian nephrology experts on the potential benefits of multispecies probiotic supplementation in CKD patients, focusing on improving their quality of life, delaying disease progression, and ultimately augmenting survival outcomes.