Probiotics in septic acute kidney injury, a double blind, randomized control trial
Jonathan S. Chávez-Íñiguez, Miguel Ibarra‐Estrada, Alejandro Martínez Gallardo-González, Ari Cisneros-Hernández, Rolando Claure‐Del Granado, Gael Chávez-Alonso, Eduardo M. Hernández-Barajas, Alexia C. Romero-Muñoz, Fidel Ramos-Avellaneda, Manuel Luis Prieto-Magallanes, Marcela Plascencia-Cruz, Jarumi A. Tanaka-Gutiérrez, Cristina Pérez-Hernández, Guillermo Navarro‐Blackaller, Ramón Medina-González, Luz Alcántar-Vallín, Karina Renoirte-López, Guillermo García-García
Abstract
Introduction During acute kidney injury (AKI) due to sepsis, the intestinal microbiota changes to dysbiosis, which affects the kidney function recovery (KFR) and amplifies the injury. Therefore, the administration of probiotics could improve dysbiosis and thereby increase the probability of KFR.Methods In this double-blind clinical trial, patients with AKI associated with sepsis were randomized (1:1) to receive probiotics or placebo for 7 consecutive days, with the objectives of evaluate the effect on KFR, mortality, kidney replacement therapy (KRT), urea, urine volume, serum electrolytes and adverse events at day 7.Results From February 2019 to March 2022, a total of 92 patients were randomized, 48 to the Probiotic and 44 to Placebo group. When comparing with placebo, those in the Probiotics did not observe a higher KFR (HR 0.93, 0.52–1.68, p = 0.81), nor was there a benefit in mortality at 6 months (95% CI 0.32–1.04, p = 0.06). With probiotics, urea values decreased significantly, an event not observed with placebo (from 154 to 80 mg/dl, p = 0.04 and from 130 to 109 mg/dl, p = 0.09, respectively). Urinary volume, need for KRT, electrolyte abnormalities, and adverse events were similar between groups. (ClinicalTrial.gov NCT03877081) (registered 03/15/2019).Conclusion In AKI related to sepsis, probiotics for 7 consecutive days did not increase the probability of KFR, nor did other variables related to clinical improvement, although they were safe.