Effects of probiotic supplementation on disease progression in patients with moderate to severe chronic kidney disease: a randomized controlled trial

Abstract Chronic kidney disease (CKD) affects approximately 10% of the global population, with limited therapeutic options to slow progression in moderate stages. The gut-kidney axis contributes to CKD progression, and probiotics are being investigated as potential therapeutic modulators. This double-blind, randomized, placebo-controlled trial investigated the effect of probiotic supplementation on CKD progression. Seventy-two patients with CKD stages 3 or 4 received either Lactobacillus plantarum (10 1 ⁰ CFU daily) or placebo for six months. The primary outcome was the change in estimated glomerular filtration rate (eGFR). The probiotic group demonstrated a significant increase in eGFR in contrast to a significant decline in the same variable in the placebo group. Treatment assignment was the sole independent predictor of eGFR change, with benefits observed across CKD stages 3 and 4, and in both diabetic and non-diabetic patients. Urinary indoxyl sulfate levels did not significantly differ between groups, and no correlation was found between its changes and eGFR improvement. No probiotic participants experienced CKD progression, compared to 8.6% in the placebo group. These findings suggest that Lactobacillus plantarum supplementation significantly ameliorates eGFR in patients with moderate to severe CKD through mechanisms independent of indoxyl sulfate reduction. Trial Registration : This trial was registered with ClinicalTrials.gov (Registration Number: NCT06863194) Registration date: 13 May 2025.