Probiotic Intake and Inflammation in Patients With Chronic Kidney Disease: An Analysis of the CKD-REIN Cohort

Abstract

Background and aims: Little is known about the effects of probiotics on inflammation in the context of chronic kidney disease (CKD). We investigated the association between probiotic intake and inflammation in patients with moderate-to-advanced CKD.

Methods: We performed a cross-sectional study of 888 patients with stage 3-5 CKD and data on serum C-reactive protein (CRP) levels and a concomitant food frequency questionnaire. We estimated the odds ratios (ORs) [95% confidence interval (CI)] for various CRP thresholds (>3, >4, >5, >6, and >7 mg/L) associated with three intake categories (no yoghurt, ordinary yoghurt, and probiotics from yoghurts or dietary supplements) and two frequency categories (daily or less than daily).

Results: The 888 study participants (median age: 70; men: 65%) had a median estimated glomerular filtration rate of 28.6 mL/min/1.73 m2 and a median [interquartile range] CRP level of 3.0 [1.6, 7.0] mg/L. Fifty-seven percent consumed ordinary yoghurt and 30% consumed probiotic yoghurt. The median intake frequency for yoghurt and probiotics was 7 per week. Relative to participants not consuming yoghurt, the ORs [95% CI] for CRP > 6 or >7 mg/L were significantly lower for participants consuming ordinary yoghurt (0.58 [0.37, 0.93] and 0.57 [0.35, 0.91], respectively) and for participants consuming probiotics (0.54 [0.33, 0.9] and 0.48 [0.28, 0.81], respectively), independently of age, sex, body mass index, CKD stage, cardiovascular disease, and fibre, protein and total energy intakes. The ORs were not significantly lower for CRP thresholds >3, >4, and >5 mg/L and were not significantly greater in daily consumers than in occasional consumers.

Conclusion: We observed independent associations between the consumption of yoghurt or probiotics and lower levels of inflammation in patients with CKD. There was no evidence of a dose-effect relationship.

Clinical trial registration: [https://www.clinicaltrials.gov/ct2/show/NCT03381950], identifier [NCT03381950].

Keywords: C-reactive protein; chronic kidney disease; epidemiology; inflammation; probiotic; yoghurt.

Conflict of interest statement

SW received a grant from ISN-H4KH Initiative, outside the submitted work. LK received a grant from Fresenius Kabi outside the submitted work, together with consulting fees from AstraZeneca, Dr. Shäre, and Fresenius Kabi. DF received a grant from Fresenius Medical Care outside the submitted work, consulting fees from Fresenius Kabi and Sanofi, and honoraria from Lilly Fresenius Kabi, Sanofi, Vifor, and Astellas. ZM received honoraria from AstraZeneca and Boehringer Ingelheim. M-CB-R received honoraria from MAYOLY SPINDLER and GILEAD. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Wagner, Merkling, Metzger, Koppe, Laville, Boutron-Ruault, Frimat, Combe, Massy, Stengel and Fouque.

Figures

FIGURE 1

Study flowchart.

FIGURE 2

The median (IQR) serum CRP concentration as a function of the CKD stage. The CRP levels rise significantly (p < 0.001) with the CKD stage. To facilitate visual comparisons, outliers (including some >300 mg/L) are not displayed. The whiskers correspond to 1.5 times the IQR.

FIGURE 3

Adjusted odds ratios (95% CI) for various CRP thresholds as a function of intakes of ordinary yoghurt and probiotics (A) in all patients (N = 888) and (B) in patients not on KRT (N = 818). The adjustment variables included the CRP assay method, age, sex, educational level, BMI, history of atheromatous CVD, CKD stage, and intakes of starch, eggs, sweet snacks, protein, fibre, and energy.