Best Probiotics For Kidney Disease

It may be overwhelming with all the probiotic options out there when you have kidney disease. You may even be asking yourself if probiotics are safe for kidney disease.

My name is Candace Mooney. I’m a registered dietitian and board certified specialist in renal nutrition. I’m here to help you learn about the best probiotics for kidney disease!

We’ll talk about what makes a probiotic, the benefits of a probiotic with kidney disease, strains of probiotics that are best for kidney disease, and specific brands I’ll typically recommend to my patients with chronic kidney disease (CKD). 

And of course, we’ll talk about ways to incorporate foods that contain probiotics and prebiotics!

What Exactly are Probiotics?

Probiotics are live microorganisms (bacteria, viruses, and yeasts) that live in your digestive tract and make up what’s called our gut microbiome. 

We all already have probiotics in our bodies, but having a supplement can help add more of the good bacteria to help fight off the bad ones in your gut. 

To make sure that the gut microbiome is growing healthy microorganisms, it needs a good food source. Kind of like us! Prebiotics are the food source for our probiotics and they are just as important to our health as probiotics. We’ll talk about these more a little later on!

Are Probiotics Safe for Kidney Disease?

Yes! Probiotics are safe for most people with kidney disease. In fact, probiotics may be very beneficial for kidney disease! 

Gut dysbiosis (altered gut microbiome) coexists with kidney disease. Your kidneys and digestive system are actually connected so optimizing your gut microbiome can optimize your kidney health! 

Potential Risks and Considerations of Probiotics with CKD

Before running to the store to get probiotics, it is important to consult with your healthcare provider first! 

Probiotics can interact with certain medications and treatments, specifically antibiotics and antifungals. If the interaction occurs, then the effectiveness can be lowered. 

There is also a potential risk for an increase of bacterial load that can be an issue for some people, especially if you’ve had a kidney transplant. By talking to your health care provider, this can help you have a safe approach to incorporating probiotics! 

Benefits of Probiotics for CKD

Let’s talk about all of the exciting benefits of creating a healthy gut microbiome with kidney disease!

Probiotics Decrease Uremic Toxins 

Chronic kidney disease causes an increase of urea and ammonia (increasing pH) in the gut. This causes certain bacteria to produce uremic toxins, which decreases the good bacteria in your gut!

We can then fix this problem by adding more good bacteria to your gut to help decrease the uremic toxin compounds! (1) 

Probiotics Decrease Inflammation

Inflammation is increased because of the urea and ammonia that are produced in your bowel, which then compromises your intestinal barrier. 

Probiotics help with this issue by improving your intestinal barrier and lining that then helps with decreasing the inflammation that was caused.(2)

Probiotics Reduce Risk of Digestive Infections

CKD patients are more at risk for digestive infections because of urea buildup. The urea can cause the intestinal barrier to be damaged that then allows bacteria to enter and cause infections. 

The image below shows the intestinal lining of a healthy gut versus one with gut dysbiosis. It shows how inflammation can decrease your intestinal mucosal lining and disturb your tight junctions allowing those larger particles to enter your bloodstream. 

Credit: VectorMine

Once again, probiotics come in and save the day by balancing the good bacteria in the gut to push out the bad ones! (3)

Best Probiotic Strains for Kidney Disease

Here’s an outline of the best probiotic strains for kidney disease. Each strain is broken down by its health benefits in relation to kidney disease. It’s important to note some of these studies are done on mice and show only preliminary findings.

1. Lactobacillus rhamnosus (4)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces uremic toxins
• Improves the gut barrier function
• Reduces inflammation in the intestines

 2. Bifidobacterium bifidum (5)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces inflammation in the intestines
• Prevents the absorption of harmful uremic toxins (p-cresol and indoxyl sulfate) in the bloodstream and metabolizes them in the gut

3. Saccharomyces boulardii (6)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces inflammation in the intestines
• Improves or acts as renal antioxidant defense
• Beneficial impact on glomerular structure and renal function

 4. Lactobacillus plantarum/Lactobacillus paracasei (7)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces renal calcium oxalate stones
• Reduces uremic toxins

5. Bifidobacterium animalis (8)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces uremic toxins

6. Bifidobacterium infantis (9)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces uremic toxins
• Reduces inflammation in the intestines

7. Bifidobacterium lactis (10)

• Helps improve gut health by balancing the bacteria in the microbiome
• Reduces uremic toxins
• Reduces inflammation in the intestines

8. Lactobacillus casei (11)

• Helps improve gut health by balancing the bacteria in the microbiome
• Stops/slows down kidney injury

How to Choose a Good Probiotic Supplement

When it comes to recommending probiotics for CKD patients, things can get a bit murky! 

The exact dosage, form (capsules vs powders), and how long to take them aren’t really set in stone. Most studies do suggest taking probiotics with meals or right after eating. 

Renal Dietitian Recommendation for Probiotic Supplement with Kidney Disease:

My general recommendation for taking a probiotic with kidney disease is to shoot for around 50 billion CFU’s with a variety of strains mentioned above. 

I also typically recommend using one of the specific probiotic supplements below.

Brands of Probiotic Supplements for CKD patients:

• Renadyl: This is the brand I recommend most frequently to start once a day for about a week or two and then as tolerated, go up to one capsule twice daily. You can purchase it through our FullScript Store and enjoy up to 15% off. 
• Ultiren: This is another option for a probiotic specifically made for kidney disease. There are 3 different versions that differ in CFU amount and strains.

Check out other vitamins and supplements I recommend for kidney disease in the Renal Dietitian’s Guide to Vitamins and Supplements for Chronic Kidney Disease blog.

Probiotics in Food

As a dietitian, I always prioritize getting probiotics through food first! Fermented foods are a great way to add probiotics through your diet! 

List of fermented foods with probiotics:

High sodium fermented foods are kimchi, sauerkraut, and miso. You can fit these in but be mindful of the sodium!

Sauerkraut Caveat! 

Sauerkraut is only a probiotic food when processed correctly! Here is how you will know! 

Refrigerated sauerkraut contains live probiotics and is found in the chilled section of the grocery store! 

Canned sauerkraut is pasteurized during canning, which destroys the probiotics. Sauerkraut with vinegar or sweeteners do not contain probiotics! 

Prebiotics

Prebiotics are found in foods or supplements that help feed the good bacteria in the body and improve the balance of the gut microbiome. 

Without prebiotics, the probiotics don’t have food to eat. This makes it hard for the probiotics to survive. Prebiotics are essential to creating a good environment for your probiotics to thrive.

Foods that are high in prebiotics are asparagus, sugar beet, garlic, chicory, onion, Jerusalem artichoke, wheat, honey, banana, tomato, rye, soybean, cow’s milk, peas, beans, sourdough bread, and many other things!

If you focus on getting enough fruits and vegetables in your diet, you are most likely providing your probiotics with good prebiotics!

Short Chain Fatty Acids (SCFAs)

SCFAs are produced when dietary fibers are fermented by the gut bacteria and show many benefits for gut health! This helps with the balance of a healthy gut microbiome like we mentioned earlier! 

SCFAs decrease inflammation and help maintain the tightness of the gut lining while also protecting it from letting harmful things come through the barrier. Remember the image above?

SCFAs can be added into your diet by adding more fruits and vegetables! 

Action Plan

Adding probiotics and prebiotics to your diet can really boost your gut health when you have chronic kidney disease. These good bacteria help your kidneys by reducing harmful toxins and inflammation.

Look for probiotic supplements like Renadyl or Ultiren, and don’t forget about tasty fermented foods like yogurt, kefir, and refrigerated sauerkraut—they’re packed with helpful bacteria, too! 

Make sure you’re getting at least 2 fruit servings and 3 vegetable servings per day to increase your prebiotic intake. Focus on those prebiotic foods we mentioned earlier.

Remember to check with your doctor before starting any new supplements, especially if you’ve had a kidney transplant.

Taking care of your gut microbiome can lead to better kidney health!

This article was co-written by dietetic intern Reagan Baker & reviewed, edited, and co-written by Candace Mooney, MS RDN CSR.