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Current Clinical Pharmacology


ISSN (Print): 1574-8847
ISSN (Online): 2212-3938

Systematic Review Article

Effects of Probiotics on Diabetic Nephropathy: A Systematic Review

Author(s): Eugenia Vlachou*, Anastasia Ntikoudi, Ourania Govina, Maria Lavdaniti, Nikolaos Kotsalas, Athanasios Tsartsalis and George Dimitriadis

Volume 15, Issue 3, 2020

Page: [234 - 242] Pages: 9

DOI: 10.2174/1574884715666200303112753

Price: $65


Background: Diabetic Nephropathy is a frequent complication of diabetes mellitus due to functional and structural modifications in multiple kidney compartments. Probiotics have risen lately as a forthcoming therapeutic intervention but they have not been systematically evaluated in diabetic nephropathy so far. The aim of this systematic review was to evaluate randomized controlled trials and experimental studies assessing the effect of probiotic supplements on diabetic nephropathy.

Methods: An extensive literature search was conducted through electronic databases (PubMed, Scopus, Cinahl and Medline) with the Medical Subject Headings and entry terms of “diabetic nephropathy”, “diabetic renal disease” and “probiotics”. The search yielded 116 results, 9 of which met the inclusion criteria for this systematic review.

Results: Most of the microorganisms used in the studies belonged to the Lactobacillus and Bifidobacterium genus. The dosage ranged from 2×107 to 6×1010 CFU/ g. The form of the probiotics varied across the studies (capsules, sachets, soy milk, kefir and honey). The majority of the studies demonstrated the benefits of probiotic supplementation on the reduction of inflammation, oxidative stress and on the amelioration of renal function biomarkers in subjects with diabetic nephropathy. No major gastrointestinal adverse events were observed during the intervention time with probiotics.

Conclusion: Findings of this systematic review demonstrate the positive impact of probiotics on Diabetic Nephropathy without any major adverse events. Moreover, future larger randomized controlled trials with bigger samples and longer follow-up time are deemed necessary for further valid results on the effectiveness of probiotic supplementation on Diabetic Nephropathy.

Keywords: Diabetic nephropathy, diabetic renal disease, probiotics, diabetic kidney disease, diabetes, hypolipidemic drugs.

Graphical Abstract
Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: Diagnosis, prevention, and treatment. Diabetes Care 2005; 28(1): 164-76.
[] [PMID: 15616252]
Atlas D. International diabetes federation IDF Diabetes Atlas. 7th ed. Brussels, Belgium: International Diabetes Federation 2015.
Caramori ML, Parks A, Mauer M. Renal lesions predict progression of diabetic nephropathy in type 1 diabetes. J Am Soc Nephrol 2013; 24(7): 1175-81.
[] [PMID: 23687360]
Fioretto P, Mauer M. Histopathology of diabetic nephropathy. Semin Nephrol 2007; 27(2): 195-207.
[] [PMID: 17418688]
Tyagi I, Agrawal U, Amitabh V, Jain AK, Saxena S. Thickness of glomerular and tubular basement membranes in preclinical and clinical stages of diabetic nephropathy. Indian J Nephrol 2008; 18(2): 64-9.
[] [PMID: 20142905]
Drummond K, Mauer M. International Diabetic Nephropathy Study Group. The early natural history of nephropathy in type 1 diabetes: II. Early renal structural changes in type 1 diabetes. Diabetes 2002; 51(5): 1580-7.
[] [PMID: 11978659]
Osterby R, Tapia J, Nyberg G, et al. Renal structures in type 2 diabetic patients with elevated albumin excretion rate. APMIS 2001; 109(11): 751-61.
[] [PMID: 11900054]
Bakris GL, Weir MR, Shanifar S, et al. RENAAL Study Group. Effects of blood pressure level on progression of diabetic nephropathy: Results from the RENAAL study. Arch Intern Med 2003; 163(13): 1555-65.
[] [PMID: 12860578]
Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: Global dimension and perspectives. Lancet 2013; 382(9888): 260-72.
[] [PMID: 23727169]
Christensen PK, Larsen S, Horn T, Olsen S, Parving HH. Causes of albuminuria in patients with type 2 diabetes without diabetic retinopathy. Kidney Int 2000; 58(4): 1719-31.
[] [PMID: 11012906]
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352(9131): 837-53.
Sleight P. The HOPE study (Heart Outcomes Prevention Evaluation). J Renin Angiotensin Aldosterone Syst 2000; 1(1): 18-20.
[] [PMID: 11967789]
Brenner RBM, Cooper ME, De Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861-9.
Patel A, MacMahon S, Chalmers J, et al. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the Advance trial): A randomised controlled trial. Lancet 2007; 370(9590): 829-40.
[] [PMID: 17765963]
Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P. Irbesartan in patients with type 2 diabetes and microalbuminuria study group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345(12): 870-8.
[] [PMID: 11565519]
Lewis SJ, Sacks FM, Mitchell JS, et al. Effect of pravastatin on cardiovascular events in women after myocardial infarction: The Cholesterol and Recurrent Events (CARE) trial. J Am Coll Cardiol 1998; 32(1): 140-6.
[] [PMID: 9669262]
Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial. Lancet 2002; 360(9326): 7-22.
[] [PMID: 12114036]
Waters DD, Guyton JR, Herrington DM, McGowan MP, Wenger NK, Shear C. TNT steering committee members and investigators. Treating to New Targets (TNT) study: Does lowering low-density lipoprotein cholesterol levels below currently recommended guidelines yield incremental clinical benefit? Am J Cardiol 2004; 93(2): 154-8.
[] [PMID: 14715339]
Sharp Collaborative Group. Study of Heart and Renal Protection (SHARP): Randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease. Am Heart J 2010; 160(5): 785-94.
[] [PMID: 21095263]
Palacios T, Vitetta L, Coulson S, Madigan CD, Denyer GS, Caterson ID. The effect of a novel probiotic on metabolic biomarkers in adults with prediabetes and recently diagnosed type 2 diabetes mellitus: Study protocol for a randomized controlled trial. Trials 2017; 18(1): 7.
Gerritsen J, Smidt H, Rijkers GT, de Vos WM. Intestinal microbiota in human health and disease: The impact of probiotics. Genes Nutr 2011; 6(3): 209-40.
[] [PMID: 21617937]
Panwar H, Rashmi HM, Batish VK, Grover S. Probiotics as potential biotherapeutics in the management of type 2 diabetes - prospects and perspectives. Diabetes Metab Res Rev 2013; 29(2): 103-12.
[] [PMID: 23225499]
Larsen N, Vogensen FK, van den Berg FWJ, et al. Gut microbiota in human adults with type 2 diabetes differs from non-diabetic adults. PLoS One 2010; 5(2)e9085
[]] [PMID: 20140211]
Cox AJ, West NP, Cripps AW. Obesity, inflammation, and the gut microbiota. Lancet Diabetes Endocrinol 2015; 3(3): 207-15.
[] [PMID: 25066177]
Belkaid Y, Hand TW. Role of the microbiota in immunity and inflammation. Cell 2014; 157(1): 121-41.
[] [PMID: 24679531]
Saad MJA, Santos A, Prada PO. Linking Gut Microbiota and inflammation to obesity and insulin resistance. Physiology (Bethesda) 2016; 31(4): 283-93.
[] [PMID: 27252163]
Tonucci LB, Santos KMOD, Ferreira CLDLF, Ribeiro SMR, Oliveira LLD, Martino HSD. Gut microbiota and probiotics: Focus on diabetes mellitus. Crit Rev Food Sci Nutr 2017; 57(11): 2296-309.
[] [PMID: 26499995]
Rad AH, Abbasalizadeh S, Vazifekhah S, et al. The future of diabetes management by healthy probiotic microorganisms. Curr Diabetes Rev 2017; 13(6): 582-9.
[] [PMID: 27758705]
Akbari V, Hendijani F. Effects of probiotic supplementation in patients with type 2 diabetes: Systematic review and meta-analysis. Nutr Rev 2016; 74(12): 774-84.
[] [PMID: 27864537]
Soleimani A, Zarrati Mojarrad M, Bahmani F, et al. Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects. Kidney Int 2017; 91(2): 435-42.
[] [PMID: 27927601]
Mazruei Arani N, Emam-Djomeh Z, Tavakolipour H. Shara-fati-Chaleshtori R, Soleimani A, Asemi Z. The effects of pro-biotic honey consumption on metabolic status in patients with diabetic nephropathy: A randomized, double-blind, controlled trial. Probiotics Antimicrob Proteins 2019; 11(4): 1195-201.
[] [PMID: 30218286]
Mafi A, Namazi G, Soleimani A, Bahmani F, Aghadavod E, Asemi Z. Metabolic and genetic response to probiotics supplementation in patients with diabetic nephropathy: A randomized, double-blind, placebo-controlled trial. Food Funct 2018; 9(9): 4763-70.
[] [PMID: 30113051]
Miraghajani M, Zaghian N, Mirlohi M, Feizi A, Ghiasvand R. The impact of probiotic soy milk consumption on oxidative stress among type 2 diabetic kidney disease patients: A randomized controlled clinical trial. J Ren Nutr 2017; 25(5): 317-24.
Miraghajani M, Zaghian N, Dehkohneh A, Mirlohi M, Ghiasvand R. Probiotic soy milk consumption and renal function among type 2 diabetic patients with nephropathy: A randomized controlled clinical trial probiotics. Antimicrob Proteins 2017; 11(1): 124-32.
Abbasi B, Ghiasvand R, Mirlohi M. Kidney function improvement by soy milk containing Lactobacillus plantarum A7 in type 2 diabetic patients with nephropathy: A double-blinded randomized controlled trial. Iran J Kidney Dis 2017; 11(1): 36-43.
[PMID: 28174351]
Firouzi S, Mohd-Yusof B-N, Majid H-A, Ismail A, Kamaruddin N-A. Effect of microbial cell preparation on renal profile and liver function among type 2 diabetics: A randomized controlled trial. BMC Complement Altern Med 2015; 15: 433.
[] [PMID: 26654906]
Punaro GR, Maciel FR, Rodrigues AM, et al. Kefir administration reduced progression of renal injury in STZ-diabetic rats by lowering oxidative stress. Nitric Oxide 2014; 37: 53-60.
[] [PMID: 24406684]
Lu Y-C, Yin L-T, Chang W-T, Huang J-S. Effect of Lactobacillus reuteri GMNL-263 treatment on renal fibrosis in diabetic rats. J Biosci Bioeng 2010; 110(6): 709-15.
[] [PMID: 20691633]
Zheng HJ, Guo J, Jia Q, et al. The effect of probiotic and synbiotic supplementation on biomarkers of inflammation and oxidative stress in diabetic patients: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2019; 142: 303-13.
[] [PMID: 30794924]
Jia L, Jia Q, Yang J, Jia R, Zhang H. Efficacy of probiotics supplementation on chronic kidney disease: A systematic review and meta-analysis. Kidney Blood Press Res 2018; 43(5): 1623-35.
[] [PMID: 30380555]
Khalili L, Alipour B, Asghari Jafar-Abadi M, et al. The effects of Lactobacillus casei on glycemic response, serum sirtuin1 and fetuin-A levels in patients with type 2 diabetes mellitus: A randomized controlled trial. Iran Biomed J 2019; 23(1): 68-77.
[] [PMID: 29803203]
Yadav H, Jain S, Sinha PR. Effect of skim milk and dahi (yogurt) on blood glucose, insulin, and lipid profile in rats fed with high fructose diet. J Med Food 2006; 9(3): 328-35.
[] [PMID: 17004894]
Yadav H, Jain S, Sinha PR. Antidiabetic effect of probiotic dahi containing Lactobacillus acidophilus and Lactobacillus casei in high fructose fed rats. Nutrition 2007; 23(1): 62-8.
[] [PMID: 17084593]
McFarlane C, Ramos CI, Johnson DW, Campbell KL. Prebiotic, probiotic, and synbiotic supplementation in chronic kidney disease: A systematic review and meta-analysis. J Ren Nutr 2019; 29(3): 209-20.
[] [PMID: 30366767]

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