Нужны ли пробиотики в нефрологии?

Нарушения взаимодействия между хозяином и микробиотой патофизиологически значимы у пациентов с хронической болезнью почек (ХБП). При этом эффект является двунаправленным: с одной стороны, уремия влияет как на состав, так и на метаболизм микробиоты кишечника, а с другой стороны – уремические токсины возникают и удаляются в результате микробного метаболизма. Поэтому пробиотические препараты могут быть эффективным инструментом коррекции. Известны три позитивных механизма влияния пробиотиков: элиминация уремических удерживающих растворенных веществ (УУРВ), при которой происходит снижение превращения аминокислот в н-оксид триметиламина, п-крезилсульфат или индоксилсульфат; увеличение содержания в плазме крови короткоцепочечных жирных кислот; усиление гидролиза мочевины. ХБП является одним из частых осложнений сахарного диабета. Однако при этом заболевании не каждый способ введения пробиотиков может быть эффективным. Так, существенного влияния не наблюдалось при применении пробиотического йогурта. Многообещающие результаты даёт применение капсулированных пробиотиков: метаболические профили в 11 из 24 биомаркеров были положительными. Пробиотикотерапия может успешно применяться при заместительной почечной терапии.

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