Evaluation of the anemia-ameliorating effects of changes in the intestinal microbiota in hemodialysis patients: a study of four cases

Previous studies have shown that trivalent iron promoted the growth of Lactobacillus and Bifidobacteria, which enhanced the absorption of iron from the intestines. In our study, 4 hemodialysis patients were given an oral Lactobacillus preparation; i.e., BIO-THREE® OD tablets, at a dose of 2 tablets 3 times a day, and the effects of the resultant changes in the intestinal microbiota on iron metabolism and anemia-related indices were examined. An analysis of the changes in the intestinal microbiota revealed that in patients 1, 2, and 3 the frequency of the Firmicutes phylum was increased after BIO-THREE® OD tablets had been orally administered for one month. An examination of the effects of these changes on iron metabolism showed elevated transferrin saturation levels in patients 1, 2, and 4 after BIO-THREE® tablets had been orally administered for one month. In addition, patients 1 and 4 exhibited decreased serum levels of hepcidin-25 after the BIO-THREE® OD tablets had been orally administered for 3 months. The analysis of anemia-related indices showed that the oral administration of BIO-THREE® OD tablets had little effect on hemoglobin levels. Although the patients who displayed changes in their intestinal microbiota did not overlap with those who showed changes in iron metabolism, our findings suggested that the oral administration of BIO-THREE® OD tablets promoted the ferric-reducing effects of intestinal bacteria and enhanced iron absorption.