Abstract: Objective To guide rational clinical use of synbiotics in the treatment of chronic kidney disease and the design of large-scale randomized controlled trials, we systematically evaluate and meta-analysis the effect of synbiotics on patients with chronic kidney disease. Methods Four English databases and four Chinese databases were searched by using key words such as "Synbiotics" and "Chronic Kidney Disease". Six RCTs and four non-randomized controlled trials were screened by inclusion criteria. For descriptive studies, qualitative analysis was used; for randomized controlled trials, meta-analysis was conducted. The change of p-Cresyl sulfate (PCS) content in the blood before and after the intervention of synbiotics was selected as the primary outcome. The secondary outcomes were constitution and abundance changes in gut microbiota, intestinal function, uremic toxins such as creatinine, urea, urea nitrogen and inflammatory cytokines. The random or fixed effect model was selected according to heterogeneity. Results In 4 non-randomized controlled trials, 88 patients were included in the study. Six randomized controlled trials included 237 patients, of which 116 were in the synbiotics group and 121 in the control group. Four non-RCT The meta-analysis showed that synbiotics group significantly differed in the reduction of PCS compared with placebo group, SMD=-0.90, 95%CI (-1.67, -0.14), P=0.02; whereas in secondary outcomes such as creatinine, urea, interleukin 6 (IL-6), tumor necrosis factor (TNF-α), gastrointestinal symptoms scores and renal tubular filtration rate (eGFR), the two groups were almost the same (P>0.05). In addition, no adverse events occurred in the intervention of synbiotics. Conclusions Synbiotics may be a safe and effective treatment for patients with chronic kidney disease. However, more rigorous design and large scale multi-center randomized controlled clinical trials are needed to verify this study.