SO055PROBIOTIC BIO-THREE DECREASES SERUM PHOSPHATE LEVELS WITH INVOLVEMENT OF BACTERIA IN GUT MICROBIOMA IN HEMODIALYSIS PATIENTS: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTOLLED STUDY

Abstract Background and Aims Recent studies revealed that the importance of the gut microbioma in the development and progression of CKD. Dysbiosis of the intestinal microbiota increases uremic toxin, which damage the epithelial tight junctions and increase the permeability of the intestinal wall via endotoxemia and systemic inflammation. Some articles reported that probiotics reduced the uremic toxin and decreased inflammation biomarkers in CKD patients, while others reported no remarkable changes. Meanwhile, we have already reported that oral administration of Bifidobacterium longum in a gastro-resistant seamless capsule decreases serum phosphate levels in patients receiving haemodialysis. The aim of this study is to evaluate the efficacy of probiotics by changes of serum data, including inflammation and intestinal flora in patients receiving hemodialysis. Method A 6-month prospective, randomized, double-blind, placebo-controlled study was conducted at three hemodialysis centers. As probiotic therapy, of three-combination probiotics (Bio-Three) tablets, each containing 2 mg of lactomin (Streptococcus faecalis T-110), 10 mg of Clostridium butyricum TO-A, and 10 mg of Bacillus mesentericus TO-A, were used. The patients receiving hemodialysis were randomly assigned to the Bio-Three group (n=37) and the placebo group (n=36). In both the Bio-Three group and the placebo group, patients orally received 6 tablets 3 times daily. We evaluated the effect of probiotic on the ratio of CRP to albumin as an inflammatory biomarker, other serum data and gut microbioma before and 6 month after the start of treatment. The gut microbioma composition was analyzed by a 16s rRNA gene-based sequencing protocol. Results The ratio of CRP to albumin did not change before and after treatment in both groups. The serum phosphate levels in the Bio-Three group significantly decreased after 6-month treatment, while did not change in the placebo group. In a 16s rRNA gene-based sequencing protocol analysis, the ratio of Firmicutes, Actinomycetales and Neisseriaies significantly changed after 6 month treatment in the only probiotic group. Meanwhile, serum phosphate levels were positively correlated with the number of genus Haemephilus and gunus Neisseria in the only probiotic group. Furthermore, serum phosphate levels were negatively correlated with the number of genus Bifidobacterium in the only probiotic group. Conclusion In this study, three-combination probiotics did not decrease systemic inflammation in hemodialysis patients. Meanwhile, three-combination probiotics might decrease serum phosphate levels, and the specific bacteria in the gut microbioma might contribute to the decrease of serum phosphate levels.