Few therapies delay the progression of chronic kidney disease to end-stage kidney disease. This paper explores the possibility of using bacteriotherapy to reduce the damage of uremic toxins. Sporosarcina pasteurii is a nonpathogenic, soil-borne, alkalophilic, urease-positive bacterium that hydrolyzes urea for "enteric dialysis." The beneficial effects of S. pasteurii were first shown in vitro by using the Simulator of the Human Intestinal Microbial Ecosystem (SHIME) and then in 5/6th nephrectomized rats. During the in vitro test, 109 colony-forming units (cfus) of S. pasteurii were removed from 21 ± 4.7 mg to 228 ± 6.7 mg urea per hour. The studies showed that S. pasteurii survived exposure to gastric fluid and retained its ability to hydrolyze urea. The nephrectomized rats fed 109 cfus of live S. pasteurii daily had reduced blood urea nitrogen levels and significantly longer life spans than control animals.

COMMENTARY: Chronic kidney disease is common among dogs and cats. The cost of treatment for end-stage disease is often prohibitive: transplants cost in the range of $11,000, and dialysis, which is available at some sites in the country, often costs more than $6000 per year. The possibility of bacteriotherapy as a means to lessen BUNs and improve quality of life is interesting and certainly warrants more investigation.

In vitro and in vivo assessment of intraintestinal bacteriotherapy in chronic kidney disease. Ranganathan N, Patel BG, Ranganathan P, et al. ASAIO J 52:70-79, 2006.