Dialysis treatment can save lives but also have lasting ramifications on overall well-being, including gut health. Dialysis filters remove waste products and extra fluid from the blood when kidneys cannot, saving lives but often taking an emotional toll as well as diminishing overall well-being.

An abundance of beneficial bacteria residing within our digestive systems – known as the gut microbiome – is vitally important to overall well-being, providing essential functions like digestion, vitamin absorption and immune support, inflammation regulation, and even pain management. Unfortunately, disruptions of this delicate balance often arise among people living with Chronic Kidney Disease (CKD), leading to various health concerns and further complicating matters.

Probiotics offer the solution; live bacteria with potential health benefits when consumed. Common sources for probiotic consumption are yogurt, kimchi, and kefir products as well as nutritional supplements containing probiotics; but are Probiotics for People on Dialysis? And if so, what might their advantages be?

Understanding Probiotics and the Gut Microbiome

The human gut hosts about 100 trillion microorganisms, which are classified into two: the friendly and the hostile microbes which are also known as the gut microbiome. Probiotics are live microorganisms that when ingested confer health-related benefits. There are various strains available with specific properties and functions. 

By working in several ways to cultivate such environments, these bacteria contribute towards creating an ideal gut ecosystem:

• Competition: Probiotics directly challenge pathogenic bacteria for space and nutrients, thus, helping to regulate their number.
• Digestion: Probiotics secrete enzymes that help in the digestion and absorption of food items.
• Immune Modulation: Probiotics have immunomodulatory effects to interact with the immunity in your gut and likely reduce inflammation and overreaction.
• Short-Chain Fatty Acid Production: The use of probiotics is based on the fact that fermented fiber is used as fuel to produce products known as short-chain fatty acids that are directly consumed by cells of the gut hence enhancing the general gut health and overall digestive health.

Fiber is a further component that is critical to gut health together with prebiotics. Chicory root inulin and fructooligosaccharides (FOS) – the type of foods that feed your good bacteria, thus stimulating their growth and activity in your digestive tract; the foods include bananas and onions. The combination of the consumption of probiotics and prebiotics feeds the probiotics perfectly well in the environment created.

Can you take probiotics on dialysis?

Hemodialysis and peritoneal dialysis patients are often confronted with various issues for their diseases and comorbid conditions, including gastrointestinal problems that affect their QoL. Some common digestive concerns experienced by dialysis patients are:

• Diarrhea: This is due to factors like alteration in the rate of digestion, use of antibiotics, and restricted diets.
• Constipation: One of the causes of constipation is the effects of dialysis treatments where patients can easily become dehydrated and lose their electrolyte balance.
• Nausea and vomiting: This may be due to side effects of some medicines or disturbance of the normal flora of the gut.

This results in unpleasant sensations in the stomach, which interferes with the absorption of nutrients. This is where probiotics might help.

• Restoring Gut Balance: Probiotics may assist in the replenishment of helpful bacteria in the digestive system to achieve balance within its microflora; this in turn may improve digestion and reduce incidents of diarrhea or constipation.
• Strengthening the Gut Barrier: Probiotics can help rebuild the mucus layer of the gut, thus helping it not to be irritated by the bad bacteria and damaged by them.
• Reducing Inflammation: Some probiotic strains have anti-inflammatory compounds that can help the digestion process by reducing the inflammation in the gut and discomfort.

Furthermore, probiotics could offer additional health benefits beyond digestive health for dialysis patients:

• Reduced Inflammation: Chronic inflammation is one of the factors of chronic kidney disease (CKD) and also results in more complications than normally anticipated. Probiotics may be used to control the immunity of the gut so that the general inflammation is lowered.
• Improved Nutrient Absorption: Dialysis hampers the body’s ability to absorb nutrients from the foods we eat, but the use of probiotics could help enhance this process because they help to provide the optimal gut environment for the breakdown of complex nutrients in foods and they do this in a faster and more efficient way.
• Enhance Immune Function: A study has shown that people with good gut bacteria are likely to have a good immune system. This defense mechanism could be enhanced using probiotics among dialysis patients, implying that the patients would be less likely to get infected and hospitalization incidences would be reduced due to infections.

Read more: Can dialysis be temporary?

Studies and Considerations for Probiotic Use in Dialysis 

Research into the effectiveness of probiotic use by dialysis patients remains inconclusive and ongoing, although some peritoneal dialysis studies have produced promising results when administered to reduce digestive discomfort or improve gut health; other hemodialysis (where blood is filtered outside the body) studies have produced inconclusive findings.

Research needs to be completed on optimal probiotic strains, dosages, and long-term effects for dialysis patients in terms of strains, dosage, and long-term effects. Here are a few considerations:

• Dialysis Type: Hemodialysis or Peritoneal dialysis could have different impacts on potential benefits associated with probiotic supplements; each option could lead to unique results in terms of probiotic use.
• Underlying Medical Conditions: If you suffer from additional health conditions other than CKD, discuss probiotic use with your healthcare provider to make sure there are no conflicts with the medications you are currently taking.
• Medication Interactions: While certain probiotics don’t interact directly with medications you are currently taking, others could. Before beginning probiotic supplementation all relevant information must be disclosed to your provider as probiotic interactions could arise from certain interactions between specific pills and probiotics.

Finding and Consuming Probiotics Safely 

While probiotic supplements offer numerous potential health advantages for dialysis patients, it’s wise to first speak to either your physician or registered dietitian like Dr. Bismah Irfan before beginning any supplement regimens containing probiotics. Dr. Bismah Irfan can assess your individual needs and medical history to recommend suitable strains and dosages.

Here are a few key factors to keep in mind when purchasing probiotic supplements: 

• Strain Types: Not all probiotic strains provide equal results; different strains offer distinct advantages when taken as supplements by those living with chronic kidney disease (CKD). When selecting your supplement(s), be sure it includes well-studied strains suitable for this group – consult with your healthcare provider first to select an ideal formula that meets their individual needs.
• Dosage: Probiotic strains have different potencies; adhere to the dosage instructions on your product label or those recommended by a healthcare practitioner to minimize potential side effects and maximize overall wellness. Too high of an intake could have negative repercussions.
• Brand Reputation: When purchasing probiotic supplements, choose reliable brands known for their quality control and manufacturing standards, with independent tests performed to verify the potency and viability of probiotic strains listed on their labels. 

Read more: How long can you live on dialysis?

Probiotics Offer Potential in Dialysis Care

Research on probiotics for dialysis patients remains in its infancy; however, preliminary findings show promising benefits to gut and overall well-being. Probiotics could alleviate digestive issues, reduce inflammation, and help improve nutrient absorption as well as immune function – potentially increasing levels of uremic toxin over time and immune functioning as a whole. Certainly, the impact this area holds for further investigation, yet its promise makes for exciting reading!

At Dr. Bismah Irfan‘s dialysis care practice, probiotic use should never be seen as a one-size-fits-all solution. Consulting your physician or registered dietitian such as her can ensure safe and effective probiotic use as part of a personalized dialysis treatment plan. With ongoing research developments promising great promise to dialysis patients around the world in years ahead!