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Abstract

Introduction. Dysbiosis microbiota is considered as one of the consequences and impacts of high uremic toxins in patients with Chronic Kidney Disease (CKD), which can lead to an increased risk of progression and mortality. The aim of this systematic review and meta-analysis was to perform quantitative effect of microbiota modulation for estimated Glomerular Filtration Rate (eGFR), uremic toxin (total-p cresyl/total pCS), and inflammatory marker (hs-CRP) outcome among CKD patients.

Methods. Article searches were conducted from PubMed, ScienceDirect, and Cochrane Library data sources from 2010-2022. Assessment of article quality follows the rules of PRISMA (Preferred Reporting Items in Systematic Review and Meta-Analysis). Only randomized controlled trial (RCT) articles investigating the effect of symbiotic, prebiotic, of probiotic for CKD were included in the analysis. Effect size quantify from Standardized Mean Difference (SMD), using a continuous random effect model and described in the forest plot model.

Results. A total of 17 RCT studies with a total 867 CKD stage 1-5 subjects (440 subjects in the intervention group and 427 subjects in the control group). The intervention duration ranging from 1-12 months. The studies included had varied on methodologies, with significant heterogenicity (I296,96%, p

Conclusions. The administration of probiotic/prebiotic/symbiotic supplements to CKD patients resulted in significant improvements in e-GFR and reductions in total pCS. These results suggest the potential of symbiotic, prebiotic, and probiotic supplementation to improve CKD outcome.

Keywords: Chronic kidney disease, e-GFR, hs-CRP, prebiotic, probiotic, uremic toxin

Bahasa Abstract

Pendahuluan. Disbiosis microbiota merupakan salah satu dampak dari peningkatan toksin uremik pada pasien dengan penyakit Gagal Ginjal Kronik (GGK), yang dapat menyebabkan peningkatan risiko mortalitas. Tujuan dari tinjauan sistematis dan meta-analisis ini adalah untuk menilai efek kuantitatif dari modulasi mikrobiota terhadap perbaikan nilai perkiraan laju filtrasi glomerulus (eLFG), toksin uremik (total-p kresil/total pCS), dan penanda inflamasi (hs-CRP) pada pasien GGK.

Metode. Pencarian artikel dilakukan dari sumber data PubMed, ScienceDirect, dan Cochrane Library dari tahun 2010-2022. Penilaian kualitas artikel mengikuti aturan PRISMA (Preferred Reporting Items in Systematic Review and Meta-Analysis). Hanya artikel uji coba terkontrol secara acak (RCT) yang menyelidiki efek sinbiotik, prebiotik, atau probiotik untuk GGK dimasukkan dalam analisis. Ukuran efek dihitung dari Standardized Mean Difference (SMD), menggunakan model efek acak kontinu dan dijabarkan dalam model forest plot.

Hasil. Terdapat 17 penelitian RCT dengan jumlah subjek GGK stadium 1-5 sebanyak 867 subjek (440 subjek pada kelompok intervensi dan 427 subjek pada kelompok kontrol). Durasi intervensi berkisar antara 1-12 bulan. Studi-studi yang dimasukkan bervariasi dalam metodologi, dengan heterogenitas yang signifikan (I296,96%, p

Kesimpulan. Terdapat perubahan signifikan dalam perbaikan eLFG dan penurunan kadar pCS total dengan pemberian suplementasi probiotik/prebiotik/sinbiotik pada pasien GGK. Hasil ini menunjukkan adanya potensi suplementasi simbiosis, prebiotik, dan probiotik untuk perbaikan GGK.

Kata Kunci: eLFG, gagal ginjal kronik, hs-CRP, prebiotik, probiotik, toksin uremik

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