Lactobacillus plantarum supplementation (10^10 CFU daily for six months) significantly ameliorates eGFR in patients with moderate to severe CKD through mechanisms independent of indoxyl sulfate reduction.
Key Findings
Results
Probiotic supplementation resulted in a significant increase in eGFR compared to a significant decline in eGFR in the placebo group over six months.
72 patients with CKD stages 3 or 4 were enrolled in the double-blind, randomized, placebo-controlled trial
Patients received either Lactobacillus plantarum at 10^10 CFU daily or placebo for six months
The primary outcome was change in estimated glomerular filtration rate (eGFR)
The probiotic group showed an increase in eGFR while the placebo group showed a decline in eGFR
Results
Treatment assignment was the sole independent predictor of eGFR change in the study population.
Multivariate analysis identified treatment assignment as the only independent predictor of eGFR change
Benefits were observed across both CKD stage 3 and CKD stage 4 subgroups
Benefits were observed in both diabetic and non-diabetic patients
This suggests the effect of Lactobacillus plantarum on eGFR was not modified by baseline CKD severity or diabetic status
Results
No patients in the probiotic group experienced CKD progression, compared to 8.6% of patients in the placebo group.
CKD progression was defined as advancement to a higher CKD stage
0% of probiotic-treated participants experienced CKD progression over the six-month period
8.6% of placebo group participants experienced CKD progression over the same period
This represents a clinically meaningful difference in disease trajectory between groups
Results
Urinary indoxyl sulfate levels did not significantly differ between groups, and changes in indoxyl sulfate were not correlated with eGFR improvement.
Indoxyl sulfate is a gut-derived uremic toxin implicated in CKD progression via the gut-kidney axis
No statistically significant difference in urinary indoxyl sulfate levels was found between the probiotic and placebo groups
No correlation was found between changes in indoxyl sulfate and eGFR improvement
These findings suggest the mechanism of benefit from Lactobacillus plantarum is independent of indoxyl sulfate reduction
Background
The study investigated Lactobacillus plantarum as a therapeutic modulator of the gut-kidney axis in moderate to severe CKD.
CKD affects approximately 10% of the global population with limited therapeutic options to slow progression in moderate stages
The gut-kidney axis is recognized as a contributor to CKD progression
The trial was registered with ClinicalTrials.gov (NCT06863194), with registration date of 13 May 2025
The study enrolled patients with CKD stages 3 or 4, representing moderate to severe disease
What This Means
This research suggests that taking a daily probiotic supplement containing Lactobacillus plantarum bacteria may help slow or even temporarily reverse the decline in kidney function seen in patients with moderate to severe chronic kidney disease (CKD). In this six-month clinical trial of 72 patients, those who took the probiotic daily showed an improvement in their kidney filtration rate (eGFR), while patients taking a placebo continued to show the expected decline. Additionally, none of the probiotic-treated patients progressed to a more advanced stage of CKD, compared to about 1 in 12 patients in the placebo group who did worsen.
Interestingly, the benefits appeared to work through a mechanism other than reducing a well-known gut-derived toxin called indoxyl sulfate, which researchers had initially suspected might be the main pathway of benefit. Levels of this toxin did not differ significantly between groups, and changes in the toxin did not correlate with improvements in kidney function. This suggests the probiotic may be helping kidneys through other, not yet fully understood biological pathways. The benefits were seen regardless of whether patients had diabetes or which stage of CKD they had (stage 3 or 4).
This research suggests that Lactobacillus plantarum supplementation could represent a low-risk adjunct strategy for slowing CKD progression, particularly given the limited therapeutic options currently available for patients in moderate stages of the disease. However, as this was a single six-month trial with 72 participants, larger and longer studies would be needed to confirm these findings and better understand the mechanisms involved before drawing firm clinical conclusions.
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Saleh S, Elnagar S, Fouda M, Sayed-Ahmed N. (2026). Effects of probiotic supplementation on disease progression in patients with moderate to severe chronic kidney disease: a randomized controlled trial.. Scientific reports. https://doi.org/10.1038/s41598-026-67044-5