Assessment of Probiotics in Reducing Uremic Toxins among Individuals with Non-Dialysis CKD.

Abstract

Background: The impact of gut-derived uremic toxins–such as indoxyl sulfate, p-cresyl sulfate, and TMAO–on metabolic disruptions and inflammation, as well as the decline of kidney function within the context of chronic kidney disease, is well established. There is increasing evidence advocating that the administration of probiotics may improve intestinal microbial imbalances and, consequently, reduce toxin formation. However, evidence relating to non-dialysis CKD populations remains inconsistent.

Methodology: This prospective interventional study took place at Department of Nephrology Faisalabad Medical University Faisalabad with the involvement of 82 adults with stage 3–4 CKD attending the nephrology outpatient department. Participants were given a daily probiotic supplement during the study period which was from January 2024 to January 2025. For each participant, measuring serum indoxyl sulfate, p-cresyl sulfate, TMAO, renal markers (eGFR, creatinine, BUN), inflammatory markers, and gastrointestinal symptoms at baseline and then after the 12 weeks interventional period took place. Analysis of the data was performed using paired statistical comparison at p<0.05 defined as the level of statistical significance.

Results: A significant reduction was observed in serum indoxyl sulfate, p-cresyl sulfate, and TMAO levels following probiotic therapy. Renal function remained largely stable, with a modest improvement in BUN, while eGFR and serum creatinine showed no significant change. Inflammatory markers decreased, and participants reported improved gastrointestinal comfort and stool consistency. No major adverse effects were noted.

Conclusion: Probiotic supplementation over twelve weeks was associated with a reduction in gut-derived uremic toxins and improvements in gastrointestinal and inflammatory profiles among non-dialysis CKD patients, with stable kidney function throughout the study period. These findings support the potential role of probiotics as a supportive measure in CKD management. Larger and longer-term studies are recommended to confirm sustainability of benefits.