Effects of Lactobacillus rhamnosus GG on Gut-Derived Uremic Toxins and Gut Microbiome in Non-Dialysis CKD Patients
Bibliographic record
Abstract
Background: Accumulation of uremic toxins in chronic kidney disease (CKD) is linked to progression to kidney failure via multiple mechanisms, including gut dysbiosis and gut-derived uremic toxins (GDUT) production. We explored the effects of Lactobacillus rhamnosus GG (GG), a probiotic, on GDUT and gut microbiome in CKD patients. Methods: We conducted a randomized, double-blinded, controlled trial. After 2-week run-in, non-dialysis CKD stage 3-5 patients were assigned to receive LGG or placebo for 8 weeks and additional 12-week follow-up. Primary outcomes were changes in serum GDUTs (Indoxyl sulfate;IS, P-cresol sulfate;PCS) at end of treatment. Secondary outcomes included fecal microbiome analysis, serum inflammatory markers, eGFR, proteinuria, and adverse effects. In parallel, in vitro effects of E.coli lysate (ECL) with/without LGG-conditioned media (LCM) were explored in Caco-2 enterocytes and THP-1 macrophages. Results: Among 60 participants (aged 70.15±12 years; 57% male; eGFR 38.17 ml/min/1.73m2), 30 each group, baseline characteristics were comparable. At the end of treatment, median changes in serum IS and PCS from baseline were lower in probiotic group (-0.89 vs +0.15 μmol/L, P<0.01) and (+0.1vs +1.0 μmol/L, P=0.01), respectively. Serum inflammatory markers were lower in probiotic group (endotoxin 0.29 vs 1.19 U/mL; P=0.02, IL-6 1.25 vs 2.52 pg/mL; P<0.01, and TNF-a 0.04 vs 0.36 pg/mL; P=0.02). The eGFR, proteinuria, and adverse effects were comparable. Fecal microbiome analysis in probiotic group showed decreased diversity and reduction in pathogenic Proteobacteria (Fig 1). In vitro, there were higher pro-inflammatory gene expression in Caco-2 and THP-1 cells with ECL, and lower enterocyte integrity. These effects were attenuated with LCM, indicating protective effects on enterocyte inflammation and integrity. Conclusions: LGG improved gut dysbiosis, attenuated GDUT production, and reduced inflammatory responses linked to CKD progression. Probiotics may have a role in retarding CKD progression. Larger RCT is warranted.Fecal microbiome analysis at end of treatment
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".