Effect of oral administration of freeze-dried Lactobacillus acidophilus on small bowel bacterial overgrowth in patients with end stage kidney disease: Reducing uremic toxins and improving nutrition

Small bowel bacterial overgrowth (SBBO), a condition found in patients with advanced chronic kidney failure, contributes to pathophysiology and decreased nutrition in the chronic dialysis population. Elevated levels of toxins including dimethylamine (DMA) and a carcinogen, nitrosodimethylamine (NDMA) for which DMA is a precursor, are found in the blood and body fluids in patients with this condition, and are generated in the small bowel by SBBO. Previous studies have shown oral non-absorbable antibiotics lower DMA in these patients possibly by decreasing or altering the responsible flora. In this study, we demonstrated that two strains (NCFM(TM) and BG2F04) of Lactobacillus acidophilus (LBA) can lower DMA and NDMA in the blood and improve nutrition. In 19 dialysis patients, treatment with twice daily oral dose of 10(9) colonies per 80 mg capsule of freeze-dried LBA resulted in a significant (P = 0.001) decrease in serum DMA from 282 +/- 91 to 163 +/- 82 mu g dL(-1). In a subgroup of seven patients, blood NDMA decreased (P = 0.0053) by an average of 46%, from 236 +/- 69 to 118 +/- 38 ng kg(-1) of blood. In six of the 19, two nutritional parameters (body weight and caloric intake) improved (P = 0.05) from 49.8 +/- 3.8 to 51.4 +/- 3.8 kg and 27.9 +/- 3.7 to 32.4 +/- 5.2 kcal kg(-1) of body weight, respectively. These findings suggest positive role for LBA in people on dialysis with end stage kidney failure. (C) 1998 Elsevier Science Ltd. All rights reserved.