Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Effect of Arabinoxylan-oligosaccharides (AXOS) on Intestinal Generation of Microbial Metabolites in Chronic Kidney Disease
Brief Summary: Chronic kidney disease is associated with the accumulation of various metabolites, i.e., uremic retention solutes. Evidence is mounting that the colonic microbiota contributes substantially to these uremic retention solutes. Indoxyl sulfate and p-cresyl sulfate are among the most extensively studied gut microbial metabolites, and are associated with cardiovascular disease, overall mortality and chronic kidney disease progression. The most important regulator of colonic bacterial metabolism is nutrient availability and especially the ratio of available fermentable carbohydrate to nitrogen, which can be modified by intake of so-called prebiotics (non-digestible food ingredients). Arabinoxylan oligosaccharides (AXOS) are a recently developed group of prebiotics, and already demonstrated a decreasing effect on intestinal generation of p-cresol in healthy individuals. Whether prebiotics in general, and AXOS more specifically, can influence intestinal generation of microbial metabolites in predialysis patients has not been studied to date. An interventional study with AXOS will therefore be initiated to test the hypothesis that AXOS can decrease intestinal generation and serum concentrations of microbial metabolites in patients with CKD not yet on dialysis.


Options:
A: Inclusion Criteria:

* age 18-80 years
* GFR \< 20 ml/min/sqm
* afferent to the outpatient clinic in the Nephrology and Dialysis Unit (Azienda Ospedaliero Universitaria Maggiore della Carità)

Drop out or Exclusion Criteria:

* subject refusing to sign the informed consent
* administration of prolonged antibacterial therapy
* dialysis initiation
* death
B: Inclusion Criteria:

* Participant is willing and able to give informed consent for participation in the trial.
* Participant has the ability to speak and read English.
* Male or Female, aged 18 years or above. Females of child-bearing potential must agree to use a medically approved method of birth control for the duration of the study. All hormonal birth control must have been in use for a minimum of three months. Acceptable methods of birth control include: Hormonal contraceptives including oral contraceptives, hormone birth control patch, vaginal contraceptive ring, injectable contraceptives, or hormone implant, double-barrier method, intrauterine devices, non-heterosexual lifestyle or agrees to use contraception if planning on changing to heterosexual partner(s), vasectomy of partner at least 6 months prior to screening.
* Estimated glomerular filtration rate (eGFR) \<15 mL/min/1.73m\^2 for the past 3 months
* In the Investigator's opinion, participant is able and willing to comply with all trial requirements.

Exclusion Criteria:

* The participant is cognitively impaired and cannot give consent or participate in the group program
* The participant has an existing relationship with the research team, such as supervisory relationship (student, employee) or familial relationship (child, spouse, etc)
* Participants who indicate that they cannot consume study treatments.
* Participants who indicates they are allergic to potatoes or corn
* Female participant who is pregnant, lactating or planning pregnancy during the course of the trial.
* History of renal transplant, ongoing dialysis, use of antibiotics (last 3-months), bowel diseases, cancer, surgically removed bowel, or any gastrointestinal surgery (e.g. intestinal resection, gastric bypass, colorectal surgery)
* Inability to consume treatment due to swallowing or GI issues and inability to obtain written informed consent.
* Participating in another interventional trial that could influence the intervention or outcome of this trial.
* Participants with uncontrolled diabetes with a hemoglobin A1C \> 10%.
* Participants who consume probiotic supplements.
* Participants with abnormal constrictions of the gastrointestinal tract, diseases of the oesophagus and/or the superior opening of the stomach (cardia), potential or existing intestinal blockage, paralysis of the intestine, megacolon, faecal impaction, appendicitis, a sudden change in bowel habits that has persisted for more than 2 weeks, undiagnosed rectal bleeding, or failure to defaecate following the use of another laxative prod.
* Participants with severe anemia (hemoglobin less than 70).
* Participants taking medications which inhibit peristaltic movement (e.g. opioids,loperamide).
* Participants taking other fiber supplements or able to maintain high fiber/adequate fiber intake through diet.
C: Inclusion Criteria:

* Age ≥ 18 and ≤ 85 years
* Chronic kidney disease stage 3b-4, i.e., with estimated glomerular filtration rate (CKD-epi) between 45 - 15 ml/min/m² 29
* Written informed consent

Exclusion Criteria:

* History of organic gastro-intestinal disease (e.g., inflammatory bowel disease, malignancy)
* History of colonic surgery
* Recipient of a renal or other solid organ transplant
* Use of pre-/pro-/syn- or antibiotics in preceding 4 weeks
D: Inclusion Criteria:

* Hemodialysis patients with arteriovenous fistula as vascular access in the upper limb and on maintenance dialysis for at least 6 months;
* Patients under conservative treatment in stages 3a and 3b (30 to 60 mL / min) of chronic kidney disease and receiving nutritional treatment for at least 6 months (adequate supply of energy 30-35kcal/kg/day and hypoproteic 0.6 g/kg/day.

Exclusion Criteria:

* Patients with autoimmune and infectious diseases, diabetes, cancer and AIDS;
* Patients with catheter for hemodialysis access;
* Patients using catabolizing drugs, supplements as antioxidant vitamin, probiotics, prebiotics, synbiotics and antibiotics.
* Patients who exercise are also deleted.

Answer: C