Synbiotic Supplementation for Chronic Constipation in Patients Under Peritoneal Dialysis: An Italian Multicenter Prospective Study

Objective: Chronic constipation is prevalent in patients undergoing peritoneal dialysis (PD), raising the risk of catheter malfunction and transmural peritonitis. Gut dysbiosis in dialysis patients can worsen constipation. Methods: A single-arm prospective study was performed to assess the effectiveness of synbiotic (fructo-oligosaccharides and Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus reuteri, and Saccharomyces boulardii) supplementation for 16 weeks in PD patients suffering from chronic constipation. The endpoints were the changes in the constipation scoring system and in laxative use. Results: Out of 106 patients, 76 patients experienced chronic constipation and 70 completed the study. After 16 weeks of synbiotic supplementation, a significant improvement in constipation score was found (−5.3; 95% CI: −5.9/−4.7; P = .001) associated with suspension (36.8%) or reduction (42.1%) of laxatives among baseline users (57/70). The findings were not influenced by age, sex, diabetes, obesity, type of PD, residual diuresis, multidrug therapy, and severe constipation at baseline. Conclusions: Synbiotic supplementation is associated with constipation relief and reduction in laxatives use.