EFFECT OF PROBIOTICS ON HUMAN BLOOD UREA LEVELS IN PATIENTS WITH CHRONIC RENAL FAILURE

Chronic Kidney Disease (CKD) accelerates cardiovascular disease (CVD), predisposes to infectious diseases and numerous other morbidities that increase mortality, that shortens the life span and impairs the patient's quality of life. Most of these abnormalities are mediated by systemic inflammation, that is common in CKD. Uremic toxins retained as a result of altered kidney function contribute significantly to this inflammatory state and the derangement in many body organs. Dysbiosis (a aquantitative and qualitative alteration of intestinal microflora), is a consecuence of changes in intestinal transit, decreased protein absorption, decrease in dietary fibre intake, treatment with oral iron and frequent use of antibiotics that are very common in CKD. The human gastrointestinal microbiota represents the largest body microbial load. This bacterial load and its products have been shown to contribute to both the progression of CKD and activation of the inflammatory cascade in CKD. Thus, gut dysbiosis characterized by a disruption of the homeostatic balance in gastrointestinal tract in CKD is associated with the production of nephrotoxins (mainly urea, indoxyl sulfate, p-cresil sulfate, etc), which are introduced to the systemic circulation, contributing to systemic inflammation, and possibly to the progression of CKD Systemic inflammation and uraemic toxins play a central role in the pathophysiology of atherosclerosis, as well as in other complications associated with CKD, and it is suggested a role of bacterial metabolites (from probiotics) in the gut, as potential uremic toxins modulators, reducing the progression of CKD and associated uremia. Probiotics are defined as "living micro-organisms" that, being administered in adequate amounts, provide a health benefit to the host. Recently, it has ben demostranted the potential benefits of probiotics in CKD. They have been shown to be associated with a change in small bowel pathobiology by modifying the metabolic actions of small bowel bacterial overgrowth, reducing the generation of toxins and carcinogens and promoting nutrition with no adverse side effects The efficacy of using different types of probiotics at different doses with the aim to reduce levels of uraemic toxins and to delay the progression of CKD has been investigated in in vitro models, animal models and in patients with CKD. However, to date, there are no large-scale intervention studies and studies on clinical events to support their widespread us