Effects of Pediococcus acidilactici GKA4 Supplementation on Proinflammatory Cytokines in Early-Stage CKD

Background: Chronic kidney disease (CKD) commonly results in elevated levels of proinflammatory cytokines such as TNF-α and IL-6. Although probiotics may modulate these markers in advanced CKD, their effects on early-stage CKD (ECKD) are unclear. This study explored the impact of a specific probiotic on these cytokines in patients with ECKD. Methods: In this randomized, double-blinded, placebo-controlled trial, individuals with CKD stages G2–3a (eGFR 45–89 mL/min/1.73 m2; ages 20–90 years) were enrolled. Participants were randomly allocated to a probiotic group (Pediococcus acidilactici GKA4) or a control group (placebo) for a six-month treatment period. TNF-α and IL-6 levels were measured in the serum and urine by ELISA, with urinary values adjusted for urine creatinine. Differences between groups were assessed using generalized estimating equations (GEEs). Results: Eighty patients (median age 57 years; median eGFR 64.1 mL/min/1.73 m2) were included in the intention-to-treat analysis, with 40 patients in each group. No significant differences between the groups in serum and urinary IL-6 or serum TNF-α levels were observed. However, there was a significant decrease in urinary TNF-α levels adjusted for urine creatinine (TNF-α/Cr) in the probiotic group compared to the control group (p = 0.017). Conclusion: Although probiotic supplementation did not alter serum TNF-α or IL-6 levels, it modulated urinary TNF-α excretion in ECKD patients. Further studies with a larger population are required to confirm the findings.