Probiotics for Nausea and Vomiting in Kidney Disease
Nausea and vomiting are very common symptoms in individuals with end-stage kidney disease and those on dialysis. These symptoms are often moderate to severe and can significantly affect the quality of life. The treatment of nausea and vomiting in renal failure is complicated by the fact that these individuals are already on numerous medications and adding more medications may lead to drug interactions. Besides, most of the currently available antiemetics drugs (drugs used to prevent nausea and vomiting) are prohibitively expensive. The presence of nausea and vomiting, even though not life-threatening in itself, can also lead the patient to cancel the dialysis session, which unfortunately may further aggravate the symptoms. The symptoms may occur at any time but are most common before or after the start of dialysis.

 

How many individuals with kidney disease develop nausea and vomiting?
As to how many people with kidney disease develop nausea and vomiting is not really known but the numbers are significant. In individuals with end-stage kidney disease, it is reported that anywhere from 1-12% develop nausea and vomiting. However, in individuals on dialysis, the numbers vary from 10%-40%. Some studies report numbers as high as 70%. especially in patients who have a delay in dialysis. The condition can develop in individuals of all ages but generally tends to be more severe in patients who have long-standing kidney disease.

 

When do nausea and vomiting develop in individuals with kidney disease?
The nausea and vomiting in dialysis patients may develop at the start of dialysis or upon completion. The individuals also feel full and have no appetite. Often the symptoms last for 5-60 minutes, and in some cases even longer. When nausea and vomiting come on at the start of dialysis, the procedure is often delayed for a few hours. In patients who have missed the dialysis session or have severe kidney disease, nausea and vomiting can last an entire day.

 

Symptoms to Watch Out For
There are several reasons for these symptoms to develop and they include the following:

• Has been linked to a sudden drop in blood pressure that occurs at the start of dialysis 

   

• Some studies show that accumulation of the waste product urea may also be associated with nausea and vomiting. The higher the concentration of urea in blood, the more intense are the symptoms.

   

• Fever has also been linked to nausea and vomiting in individuals with kidney disease

   

• Disequilibrium syndrome

   

• Anxiety

   

• Disordered gut motility (eg constipation)

   

 

Alteration in the Gut Bacteria
Recently some studies have suggested that nausea and vomiting in dialysis patients may be linked to a change in the gut flora. The studies have shown that kidney patients tend to have a gradual change in the gut bacteria which may occur due to changes in immunity, diet, dialysis, fluid and electrolyte imbalance, dehydration, and use of certain medications. The gut bacteria are responsible for maintaining the good health of not only the intestine but also the body. When the gut bacteria are altered it can lead to a whole host of symptoms including nausea and vomiting.

 

How is nausea and vomiting managed in dialysis patients?
If the individual has a known cause for nausea and vomiting, it should be managed. For example, if the patient has electrolyte imbalance (high or low potassium/calcium) this should be corrected and nausea and vomiting will resolve.

The next step is to ensure that the individual’s fluid balance is adequate and that all blood work is within normal limits.

Only sips of water should be recommended when the individual has nausea and vomiting. To prevent worsening of the symptoms, a liquid diet or a low-fat diet should be prescribed. Fats in the diet should be minimized as they can slow down bowel motility and worsen nausea and vomiting.

 

Medications
There are several classes of medications that can be used to manage nausea and vomiting. While effective, these medications are expensive. Plus, there is always a risk of drug interactions and the development of adverse side effects. So what non-medication options are left for these patients?

 

Probiotics
Recently small studies have indicated that probiotics may be useful for the management of nausea and vomiting in dialysis patients. Probiotics are a combination of live bacteria and yeast and play a vital role in replacing the ‘bad’ bacteria in the gut. The reason why probiotics may be working in dialysis patients is that there may be an alteration of the ‘good and bad’ bacteria which may be responsible for nausea and vomiting. In one recent study, the administration of probiotics to patients on dialysis significantly lowered the risk of developing nausea and vomiting. However, this is not a one-shot deal and probiotics have to be consumed regularly.

 

How do probiotics work?
When probiotics are consumed they do the following:

• Maintain a healthy balance of good bacteria in the body

   

• The good bacteria help fight off the bad bacteria

   

• Help with the digestion of food

   

• Assist with the production of vitamins

   

• Support the cell lining the gut so that bad bacteria cannot enter the body

   

• Break down medications

   

 

What can I eat that contains probiotics?
Foods that are known to contain probiotics include:

• Buttermilk

   

• Kefir

   

• Kombucha

   

• Miso

   

• Kimchi

   

• Pickles

   

• Sauerkraut

   

• Some cheeses – Cottage cheese, for instance

   

• Sourdough bread

   

• Tempeh

   

• Yogurt

   

 

You can eat any of the above foods to increase the good bacteria in the gut. The key is to eat these foods regularly so that the balance of good and bacteria is maintained.

 

Are there probiotic supplements I can take?
Yes, there are many probiotics supplements on the market. They are available as a:

• Liquid

   

• Capsule

   

• Powder

   

• Drink

   

However, it is best to consume foods that contain probiotics rather than supplements as the former is much cheaper. Plus, foods that contain probiotics are more palatable.

Do probiotics work in all dialysis patients?
Unfortunately, the studies show that probiotics do work in many dialysis patients to relieve nausea but not all. The reason why probiotics do not work in all dialysis patients is that there are many other causes of the symptoms besides alteration of bacteria in the gut.

 

Are probiotics safe for dialysis patients?
Yes, probiotics are relatively safe when consumed in small amounts. Large doses may lead to diarrhea, bloating, and excessive gas. These side effects usually occur for the first few days and then gradually disappear. Finally, before you decide to take probiotics for your nausea and vomiting, speak to your kidney doctor just to make sure they are safe.

For the best probiotics available specifically for kidney problems, be sure to visit our online store and pick up a bottle of Kidney Restore.

 

References

1. Possible prevention of uremic nausea by vitamin D receptor activators in non-dialysis patients with stage 5 chronic kidney disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5648733/
2. Management of Nausea in Patients with Chronic Kidney Disease http://www.bcrenal.ca/resource-gallery/Documents/Management%20of%20Nausea%20in%20Patients%20with%20Chronic%20Kidney%20Disease.pdf
3. Probiotics: A Fix for Nausea? https://internationalprobiotics.org/probiotics-cause-or-fix-for-nausea/
4. Efficacy of Probiotics Supplementation On Chronic Kidney Disease: a Systematic Review and Meta-Analysis
5. https://www.karger.com/Article/Fulltext/494677#:~:text=bias%20as%20well.-,Conclusion,promising%20adjuvant%20therapy%20for%20CKD.