Vol. 2, Issue 3, Part C (2016)

Abstract
Elevated serum phosphorus is a predictable accompaniment of end-stage renal disease (ESRD) in the absence or even with supplementation of phosphate binders. Because of hyperphosphatemia these patients typically require oral phosphate binders for life-long phosphorus management, in addition to dietary restrictions and maintenance dialysis. Recently, Bifidobacteria, drew attention as an experimental treatment for hyperphosphatemia. The capsulated powder of bifidobacteria reduces intestinal phosphate absorption by inhibiting the sodium-phosphate transporter in the gastrointestinal tract, also a positive correlation between serum Phosphorus levels and intestinal pH was observed. In conclusion, the mechanism for the Phosphorus-lowering effect of bifidobacteria is supposed as follows: CKD conditions increase aerobic bacteria which hydrolyze urea into ammonia. Elevated pH decreases ionization of intestinal calcium (Ca) which leads to an increase in free phosphate ions through reduction of Ca phosphate crystal precipitation. Administered bifidobacteria metabolize carbohydrates to produce SCFAs, (short chain fatty acids) resulting in acidification of the intestinal lumen. The resulting low intestinal pH increases Ca ionization, which binds with free phosphate ions as an intrinsic Phosphate binder, resulting in the reduction of serum Phosphorus levels. The purpose of this study is to report on new findings regarding bifidobacteria novel effects and to review the possibility of repurposing this powder for hyperphosphatemia treatment in dialysis patients by elucidating its safety and efficacy profiles along with its synergistic clinical benefits.