search
Back to results

Effects of Synbiotics Supplementation on the Uremic Toxin Indoxyl Sulfate Level and Constipation in End-stage Renal Disease Patients Undergoing Hemodialysis

Primary Purpose

Constipation, End Stage Renal Disease on Dialysis

Status
Unknown status
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Synbiotics containing Lactobacillus acidophilus & Bifidobacterium longum 5x10^9 CFU and FOS 60 mg
Placebo
Sponsored by
Indonesia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Constipation focused on measuring Synbiotics, Indoxyl Sulfate, Constipation, Quality of life, Dysbiosis, End-Stage Renal Disease, Hemodialysis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Aged more than 18 years old
  • Had undergone hemodialysis twice a week for a minimum of 3 months, with each visit lasting 5 hours
  • Had only undergone hemodialysis therapy (not peritoneal dialysis/kidney transplantation)
  • No history of malignancy or undergoing chemotherapy/radiation therapy
  • No history of autoimmune disease or consuming immunosuppressants
  • No history of bowel resection
  • Had never been diagnosed with Crohn's disease or ulcerative colitis

Exclusion Criteria:

  • Patients whose hemodialysis schedule was changed from twice a week to three times a week
  • Patients consuming prebiotics/probiotics/synbiotics within the past 3 weeks
  • Patients experiencing infection or is consuming antibiotics
  • Patients who are not willing to participate

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Synbiotic Arm

    Placebo Arm

    Arm Description

    Patients receiving synbiotics: Lactobacillus acidophilus & Bifidobacterium longum 5x10^9 Colony Forming Unit (CFU) and Fructooligosaccharides (FOS) 60 mg, 2 capsules/day for 60 days

    Patients receiving placebo capsules containing saccharum lactis (2 capsules/day for 60 days)

    Outcomes

    Primary Outcome Measures

    Indoxyl Sulfate concentration
    Concentration of indoxyl sulfates in the subjects' blood samples

    Secondary Outcome Measures

    Symptoms of constipation
    Constipation-related symptoms as assessed using Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Score will be assessed at the start and at the end of the study. Symptoms will be considered improved if there is a reduction of total score by 1 or more point(s).
    Constipation-related quality of life
    Constipation-related quality of life as assessed using Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire. Score will be assessed at the start and at the end of the study. Quality of life will be considered improved if there is a reduction of total score by 1 or more point(s).

    Full Information

    First Posted
    August 20, 2020
    Last Updated
    August 26, 2020
    Sponsor
    Indonesia University
    search

    1. Study Identification

    Unique Protocol Identification Number
    NCT04527640
    Brief Title
    Effects of Synbiotics Supplementation on the Uremic Toxin Indoxyl Sulfate Level and Constipation in End-stage Renal Disease Patients Undergoing Hemodialysis
    Official Title
    Effects of Synbiotics Supplementation on the Concentration of the Uremic Toxin Indoxyl Sulfate, Symptoms of Constipation, and Constipation-related Quality of Life in End-stage Renal Disease Patients Undergoing Hemodialysis
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    August 2020
    Overall Recruitment Status
    Unknown status
    Study Start Date
    September 15, 2020 (Anticipated)
    Primary Completion Date
    January 31, 2021 (Anticipated)
    Study Completion Date
    February 28, 2021 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    Indonesia University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    This is a double-blind, placebo-controlled, randomized clinical trial conducted to evaluate the effects of synbiotics supplementation on the level of the uremic toxin indoxyl sulfate, symptoms of constipation, and constipation-related quality of life in end-stage renal disease patients undergoing hemodialysis.
    Detailed Description
    One of the most common gastrointestinal symptoms in end-stage renal disease patients undergoing hemodialysis is constipation, which is one of the risk factors of microbiota dysbiosis. One effect of dysbiosis is the increased level of a uremic toxin known as indoxyl sulfate. The accumulated concentration of indoxyl sulfate in end-stage renal disease patients undergoing hemodialysis is associated with inflammation and oxidative stress, which in turn increases the risk of cardiovascular event. Constipation and an increased risk of cardiovascular event is associated with low quality of life in chronic kidney disease patients undergoing hemodialysis. Synbiotics administrations had become one of the many ways to improve gut dysbiosis as it is expected to lower the level of indoxyl sulfate and improve the symptoms of constipation and constipation-related quality of life. Although studies had investigated the role of probiotics/prebiotics/synbiotics, the role of synbiotics in lowering the concentration of the uremic toxin indoxyl sulfate remains inconclusive. Therefore, this study is conducted to demonstrate the benefits of synbiotics administration in lowering the concentration of indoxyl sulfate in end-stage renal disease patients undergoing hemodialysis, This is the first study in Indonesia investigating the effects of synbiotics supplementation in end-stage renal disease patients undergoing hemodialysis. This study is a double-blind, placebo-controlled, randomized clinical trial conducted on end-stage renal disease patients undergoing hemodialysis. Patients will be divided into two arms: synbiotics and placebo. The study will take place in the hemodialysis unit of Dr. Cipto Mangunkusumo General Hospital in September 2020 to February 2021. A total of 60 participants will be recruited for the study (30 in each arm), who will be randomized into the synbiotic arm or the placebo arm. Both investigators and patients will be blinded to the treatment, and blinding will be conducted by the pharmacy unit of Dr. Cipto Mangunkusumo General Hospital. Patients who had consented to participate will be assessed for medical history and physical examination. Food recall evaluation will also be performed by a nutritionist. Blood samples will be collected from the patient for laboratory examinations, including haemoglobin, white blood cells (WBC), platelet, urea, creatinine, albumin, and indoxyl sulfate. Patients will also be asked to complete two questionnaires: the Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire to assess the symptoms of constipation and the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire to assess constipation-related quality of life. After this, patients will be randomized into one of the two study arms. The data will serve as baseline data. Patients will receive 2 capsules containing either synbiotics or placebo per day for the next 30 days. Afterwards, the patients will undergo examination to evaluate food recall and side effects. After evaluation, the patients will once again receive 2 capsules containing either synbiotics or placebo per day for the next 30 days, and after a total 2 months of interventions, will undergo examinations similar to that done in baseline examination. The primary outcome of this study is the concentration of indoxyl sulfate in end-stage renal disease patients undergoing hemodialysis. Secondary outcomes include the symptoms of constipation and constipation-related quality of life in end-stage renal disease patients undergoing hemodialysis. This study will be done according to the principles detailed in Helsinki declaration, Guideline for Good Clinical Practice from ICH Tripartite Guideline (ICH-GCP), and had been approved by the Ethical Committee of the Faculty of Medicine of Indonesia University.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Constipation, End Stage Renal Disease on Dialysis
    Keywords
    Synbiotics, Indoxyl Sulfate, Constipation, Quality of life, Dysbiosis, End-Stage Renal Disease, Hemodialysis

    7. Study Design

    Primary Purpose
    Supportive Care
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Model Description
    This study is a double-blind, placebo-controlled, randomized clinical trial conducted on end-stage renal disease patients undergoing hemodialysis. Patients will be randomized into two arms: symbiotic and placebo. The study will take place in the hemodialysis unit of Dr. Cipto Mangunkusumo General Hospital in September 2020 to February 2021. A total of 60 participants will be recruited for the study (30 in each arm). Both investigators and patients will be blinded to the treatment, and blinding will be conducted by the pharmacy unit of Dr. Cipto Mangunkusumo General Hospital.
    Masking
    ParticipantCare ProviderInvestigator
    Masking Description
    Masking is done for participants, care provider, and investigator. Masking is assigned by the pharmacy unit of Dr. Cipto Mangunkusumo Hospital.
    Allocation
    Randomized
    Enrollment
    60 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    Synbiotic Arm
    Arm Type
    Experimental
    Arm Description
    Patients receiving synbiotics: Lactobacillus acidophilus & Bifidobacterium longum 5x10^9 Colony Forming Unit (CFU) and Fructooligosaccharides (FOS) 60 mg, 2 capsules/day for 60 days
    Arm Title
    Placebo Arm
    Arm Type
    Placebo Comparator
    Arm Description
    Patients receiving placebo capsules containing saccharum lactis (2 capsules/day for 60 days)
    Intervention Type
    Dietary Supplement
    Intervention Name(s)
    Synbiotics containing Lactobacillus acidophilus & Bifidobacterium longum 5x10^9 CFU and FOS 60 mg
    Intervention Description
    Patients will undergo baseline examination including medical history and physical examination, blood samples will be collected for hemoglobin, WBC, platelet, urea, creatinine, albumin and indoxyl sulfate level. Patients will be asked to complete 2 questionnaires the PAC-SYM and PAC-QOL questionnaires, and will undergo food recall evaluations by a nutritionist. They will then be given 2 capsules of synbiotics per day for 30 days. After 1 month of intervention, the patients will be evaluated for food recall and side effects. Afterwards, the patients will receive 2 capsules of the same synbiotics per day for the next 30 days. After 2 months of intervention, the patients' history will be taken, they will be asked to complete the PAC-SYM and PAC-QOL questionnaires, undergo food recall examination, and side effects evaluation. Blood samples will be taken for indoxyl sulfate examination.
    Intervention Type
    Other
    Intervention Name(s)
    Placebo
    Intervention Description
    Patients will undergo baseline examination including medical history and physical examination, blood samples will be collected for hemoglobin, WBC, platelet, urea, creatinine, albumin and indoxyl sulfate level. Patients will be asked to complete 2 questionnaires the PAC-SYM and PAC-QOL questionnaires, and will undergo food recall evaluations by a nutritionist. They will then be given 2 capsules of placebo per day for 30 days. After 1 month of intervention, the patients will be evaluated for food recall and side effects. Afterwards, the patients will receive 2 capsules of the same placebo per day for the next 30 days. After 2 months of intervention, the patients' history will be taken, they will be asked to complete the PAC-SYM and PAC-QOL questionnaires, undergo food recall examination, and side effects evaluation. Blood samples will be taken for indoxyl sulfate examination.
    Primary Outcome Measure Information:
    Title
    Indoxyl Sulfate concentration
    Description
    Concentration of indoxyl sulfates in the subjects' blood samples
    Time Frame
    Through study completion, an average of 60 days
    Secondary Outcome Measure Information:
    Title
    Symptoms of constipation
    Description
    Constipation-related symptoms as assessed using Patient Assessment of Constipation Symptoms (PAC-SYM) questionnaire. Score will be assessed at the start and at the end of the study. Symptoms will be considered improved if there is a reduction of total score by 1 or more point(s).
    Time Frame
    Through study completion, an average of 60 days
    Title
    Constipation-related quality of life
    Description
    Constipation-related quality of life as assessed using Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire. Score will be assessed at the start and at the end of the study. Quality of life will be considered improved if there is a reduction of total score by 1 or more point(s).
    Time Frame
    Through study completion, an average of 60 days

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: Aged more than 18 years old Had undergone hemodialysis twice a week for a minimum of 3 months, with each visit lasting 5 hours Had only undergone hemodialysis therapy (not peritoneal dialysis/kidney transplantation) No history of malignancy or undergoing chemotherapy/radiation therapy No history of autoimmune disease or consuming immunosuppressants No history of bowel resection Had never been diagnosed with Crohn's disease or ulcerative colitis Exclusion Criteria: Patients whose hemodialysis schedule was changed from twice a week to three times a week Patients consuming prebiotics/probiotics/synbiotics within the past 3 weeks Patients experiencing infection or is consuming antibiotics Patients who are not willing to participate
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Aida Lydia, MD, PhD
    Phone
    +62 812-102-8939
    Email
    draidalydia@gmail.com
    First Name & Middle Initial & Last Name or Official Title & Degree
    Tities Indra, MD
    Phone
    +62 8111-288-300
    Email
    drtities@gmail.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Aida Lydia, MD, PhD
    Organizational Affiliation
    Indonesia University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    No
    IPD Sharing Plan Description
    No plan to share individual participant data
    Citations:
    PubMed Identifier
    25093157
    Citation
    Said S, Hernandez GT. The link between chronic kidney disease and cardiovascular disease. J Nephropathol. 2014 Jul;3(3):99-104. doi: 10.12860/jnp.2014.19. Epub 2014 Jul 1.
    Results Reference
    background
    PubMed Identifier
    27383068
    Citation
    Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016 Jul 6;11(7):e0158765. doi: 10.1371/journal.pone.0158765. eCollection 2016.
    Results Reference
    background
    PubMed Identifier
    30352554
    Citation
    Hasan M, Sutradhar I, Gupta RD, Sarker M. Prevalence of chronic kidney disease in South Asia: a systematic review. BMC Nephrol. 2018 Oct 23;19(1):291. doi: 10.1186/s12882-018-1072-5.
    Results Reference
    background
    PubMed Identifier
    30501836
    Citation
    Khan YH, Mallhi TH, Sarriff A, Khan AH, Tanveer N. Prevalence of Chronic Kidney Disease in Asia: A Systematic Review of Population-Based Studies. J Coll Physicians Surg Pak. 2018 Dec;28(12):960-966. doi: 10.29271/jcpsp.2018.12.960.
    Results Reference
    background
    PubMed Identifier
    25777665
    Citation
    Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, Zhao MH, Lv J, Garg AX, Knight J, Rodgers A, Gallagher M, Kotwal S, Cass A, Perkovic V. Worldwide access to treatment for end-stage kidney disease: a systematic review. Lancet. 2015 May 16;385(9981):1975-82. doi: 10.1016/S0140-6736(14)61601-9. Epub 2015 Mar 13.
    Results Reference
    background
    PubMed Identifier
    25339487
    Citation
    Liu M, Li XC, Lu L, Cao Y, Sun RR, Chen S, Zhang PY. Cardiovascular disease and its relationship with chronic kidney disease. Eur Rev Med Pharmacol Sci. 2014 Oct;18(19):2918-26.
    Results Reference
    background
    PubMed Identifier
    27434642
    Citation
    Tong J, Liu M, Li H, Luo Z, Zhong X, Huang J, Liu R, He F, Fu J. Mortality and Associated Risk Factors in Dialysis Patients with Cardiovascular Disease. Kidney Blood Press Res. 2016;41(4):479-87. doi: 10.1159/000443449. Epub 2016 Jul 20.
    Results Reference
    background
    PubMed Identifier
    18825155
    Citation
    Kendrick J, Chonchol MB. Nontraditional risk factors for cardiovascular disease in patients with chronic kidney disease. Nat Clin Pract Nephrol. 2008 Dec;4(12):672-81. doi: 10.1038/ncpneph0954. Epub 2008 Sep 30.
    Results Reference
    background
    PubMed Identifier
    24136920
    Citation
    Allon M. Evidence-based cardiology in hemodialysis patients. J Am Soc Nephrol. 2013 Dec;24(12):1934-43. doi: 10.1681/ASN.2013060632. Epub 2013 Oct 17.
    Results Reference
    background
    PubMed Identifier
    24643131
    Citation
    Wong J, Piceno YM, DeSantis TZ, Pahl M, Andersen GL, Vaziri ND. Expansion of urease- and uricase-containing, indole- and p-cresol-forming and contraction of short-chain fatty acid-producing intestinal microbiota in ESRD. Am J Nephrol. 2014;39(3):230-237. doi: 10.1159/000360010. Epub 2014 Mar 8.
    Results Reference
    background
    PubMed Identifier
    29468835
    Citation
    Zuvela J, Trimingham C, Le Leu R, Faull R, Clayton P, Jesudason S, Meade A. Gastrointestinal symptoms in patients receiving dialysis: A systematic review. Nephrology (Carlton). 2018 Aug;23(8):718-727. doi: 10.1111/nep.13243.
    Results Reference
    background
    PubMed Identifier
    32043026
    Citation
    Sumida K, Yamagata K, Kovesdy CP. Constipation in CKD. Kidney Int Rep. 2019 Nov 13;5(2):121-134. doi: 10.1016/j.ekir.2019.11.002. eCollection 2020 Feb.
    Results Reference
    background
    PubMed Identifier
    23814466
    Citation
    Zhang J, Huang C, Li Y, Chen J, Shen F, Yao Q, Qian J, Bao B, Yao X. Health-related quality of life in dialysis patients with constipation: a cross-sectional study. Patient Prefer Adherence. 2013 Jun 18;7:589-94. doi: 10.2147/PPA.S45471. Print 2013.
    Results Reference
    background
    PubMed Identifier
    26590448
    Citation
    Ramezani A, Massy ZA, Meijers B, Evenepoel P, Vanholder R, Raj DS. Role of the Gut Microbiome in Uremia: A Potential Therapeutic Target. Am J Kidney Dis. 2016 Mar;67(3):483-98. doi: 10.1053/j.ajkd.2015.09.027. Epub 2015 Nov 15.
    Results Reference
    background
    PubMed Identifier
    30249039
    Citation
    Claro LM, Moreno-Amaral AN, Gadotti AC, Dolenga CJ, Nakao LS, Azevedo MLV, de Noronha L, Olandoski M, de Moraes TP, Stinghen AEM, Pecoits-Filho R. The Impact of Uremic Toxicity Induced Inflammatory Response on the Cardiovascular Burden in Chronic Kidney Disease. Toxins (Basel). 2018 Sep 23;10(10):384. doi: 10.3390/toxins10100384.
    Results Reference
    background
    PubMed Identifier
    27100399
    Citation
    Poesen R, Evenepoel P, de Loor H, Delcour JA, Courtin CM, Kuypers D, Augustijns P, Verbeke K, Meijers B. The Influence of Prebiotic Arabinoxylan Oligosaccharides on Microbiota Derived Uremic Retention Solutes in Patients with Chronic Kidney Disease: A Randomized Controlled Trial. PLoS One. 2016 Apr 21;11(4):e0153893. doi: 10.1371/journal.pone.0153893. eCollection 2016.
    Results Reference
    background
    PubMed Identifier
    23316359
    Citation
    Rossi M, Klein K, Johnson DW, Campbell KL. Pre-, pro-, and synbiotics: do they have a role in reducing uremic toxins? A systematic review and meta-analysis. Int J Nephrol. 2012;2012:673631. doi: 10.1155/2012/673631. Epub 2012 Dec 19.
    Results Reference
    background
    PubMed Identifier
    20929916
    Citation
    Nakabayashi I, Nakamura M, Kawakami K, Ohta T, Kato I, Uchida K, Yoshida M. Effects of synbiotic treatment on serum level of p-cresol in haemodialysis patients: a preliminary study. Nephrol Dial Transplant. 2011 Mar;26(3):1094-8. doi: 10.1093/ndt/gfq624. Epub 2010 Oct 7.
    Results Reference
    background
    PubMed Identifier
    25147806
    Citation
    Natarajan R, Pechenyak B, Vyas U, Ranganathan P, Weinberg A, Liang P, Mallappallil MC, Norin AJ, Friedman EA, Saggi SJ. Randomized controlled trial of strain-specific probiotic formulation (Renadyl) in dialysis patients. Biomed Res Int. 2014;2014:568571. doi: 10.1155/2014/568571. Epub 2014 Jul 24.
    Results Reference
    background
    PubMed Identifier
    23646054
    Citation
    Hyun HS, Paik KH, Cho HY. p-Cresyl sulfate and indoxyl sulfate in pediatric patients on chronic dialysis. Korean J Pediatr. 2013 Apr;56(4):159-64. doi: 10.3345/kjp.2013.56.4.159. Epub 2013 Apr 22.
    Results Reference
    background
    PubMed Identifier
    19692415
    Citation
    Meijers BK, De Preter V, Verbeke K, Vanrenterghem Y, Evenepoel P. p-Cresyl sulfate serum concentrations in haemodialysis patients are reduced by the prebiotic oligofructose-enriched inulin. Nephrol Dial Transplant. 2010 Jan;25(1):219-24. doi: 10.1093/ndt/gfp414. Epub 2009 Aug 19.
    Results Reference
    background
    PubMed Identifier
    29939302
    Citation
    Ramos CI, Armani RG, Canziani MEF, Dalboni MA, Dolenga CJR, Nakao LS, Campbell KL, Cuppari L. Effect of prebiotic (fructooligosaccharide) on uremic toxins of chronic kidney disease patients: a randomized controlled trial. Nephrol Dial Transplant. 2019 Nov 1;34(11):1876-1884. doi: 10.1093/ndt/gfy171.
    Results Reference
    background
    PubMed Identifier
    8893154
    Citation
    Hida M, Aiba Y, Sawamura S, Suzuki N, Satoh T, Koga Y. Inhibition of the accumulation of uremic toxins in the blood and their precursors in the feces after oral administration of Lebenin, a lactic acid bacteria preparation, to uremic patients undergoing hemodialysis. Nephron. 1996;74(2):349-55. doi: 10.1159/000189334.
    Results Reference
    background
    PubMed Identifier
    12612972
    Citation
    Takayama F, Taki K, Niwa T. Bifidobacterium in gastro-resistant seamless capsule reduces serum levels of indoxyl sulfate in patients on hemodialysis. Am J Kidney Dis. 2003 Mar;41(3 Suppl 1):S142-5. doi: 10.1053/ajkd.2003.50104.
    Results Reference
    background
    PubMed Identifier
    15648012
    Citation
    Taki K, Takayama F, Niwa T. Beneficial effects of Bifidobacteria in a gastroresistant seamless capsule on hyperhomocysteinemia in hemodialysis patients. J Ren Nutr. 2005 Jan;15(1):77-80. doi: 10.1053/j.jrn.2004.09.028.
    Results Reference
    background
    PubMed Identifier
    25147155
    Citation
    Sirich TL, Plummer NS, Gardner CD, Hostetter TH, Meyer TW. Effect of increasing dietary fiber on plasma levels of colon-derived solutes in hemodialysis patients. Clin J Am Soc Nephrol. 2014 Sep 5;9(9):1603-10. doi: 10.2215/CJN.00490114. Epub 2014 Aug 21.
    Results Reference
    background
    PubMed Identifier
    30468238
    Citation
    Esgalhado M , Kemp JA , Azevedo R , Paiva BR , Stockler-Pinto MB , Dolenga CJ , Borges NA , Nakao LS , Mafra D . Could resistant starch supplementation improve inflammatory and oxidative stress biomarkers and uremic toxins levels in hemodialysis patients? A pilot randomized controlled trial. Food Funct. 2018 Dec 13;9(12):6508-6516. doi: 10.1039/c8fo01876f.
    Results Reference
    background
    PubMed Identifier
    26772193
    Citation
    Rossi M, Johnson DW, Morrison M, Pascoe EM, Coombes JS, Forbes JM, Szeto CC, McWhinney BC, Ungerer JP, Campbell KL. Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY): A Randomized Trial. Clin J Am Soc Nephrol. 2016 Feb 5;11(2):223-31. doi: 10.2215/CJN.05240515. Epub 2016 Jan 15.
    Results Reference
    background
    PubMed Identifier
    28888762
    Citation
    Borges NA, Carmo FL, Stockler-Pinto MB, de Brito JS, Dolenga CJ, Ferreira DC, Nakao LS, Rosado A, Fouque D, Mafra D. Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial. J Ren Nutr. 2018 Jan;28(1):28-36. doi: 10.1053/j.jrn.2017.06.010. Epub 2017 Sep 6.
    Results Reference
    background
    PubMed Identifier
    35869437
    Citation
    Lydia A, Indra TA, Rizka A, Abdullah M. The effects of synbiotics on indoxyl sulphate level, constipation, and quality of life associated with constipation in chronic haemodialysis patients: a randomized controlled trial. BMC Nephrol. 2022 Jul 22;23(1):259. doi: 10.1186/s12882-022-02890-9.
    Results Reference
    derived

    Learn more about this trial

    Effects of Synbiotics Supplementation on the Uremic Toxin Indoxyl Sulfate Level and Constipation in End-stage Renal Disease Patients Undergoing Hemodialysis

    We'll reach out to this number within 24 hrs