Effects of Probiotics on Diabetic Nephropathy: A Systematic Review.

Abstract

Diabetic nephropathy is a frequent complication of diabetes mellitus as a result of functional and structural modifications in multiple kidney compartments. Probiotics have risen lately as the forthcoming therapeutic intervention but have not been systematically evaluated in diabetic nephropathy so far. The aim of this review is to systematically evaluate randomized controlled trials and experimental studies assessing the effect of probiotic supplements on diabetic nephropathy. An extensive literature search was conducted through electronic databases (Pubmed, Scopus, Cinahl and Medline) with the Medical Subject Headings and entry terms of "diabetic nephropathy", "diabetic renal disease" and "probiotics". The search yielded 116 results, 9 of which met the inclusion criteria for this review. Most of the microorganisms used in the studies belonged to the Lactobacillus and Bifidobacterium genus although they did not follow a specific dosage. The dosage ranged from 2×107 to 6×1010 CFU/ g. The form of presentation of the probiotic agents varied across the studies (capsules, sachets, soy milk, kefir and honey). The majority of the studies demonstrated the benefits of probiotic supplementation on the reduction of inflammation, oxidative stress and on the amelioration of renal function biomarkers in subjects with diabetic nephropathy. Neither of them observed any gastrointestinal adverse effects during the intervention time with probiotic supplementation. However, the limited number of the included studies does not allow the generalization of the observed results. Therefore, it is of utmost importance to conduct randomized controlled trials with larger samples and longer follow-up in order to produce more valid results on the effectiveness of probiotic supplementation in diabetic nephropathy.