Randomized Controlled Trial of Strain-Specific Probiotic Formulation (Renadyl) in Dialysis Patients SYNbiotics Easing Renal failure by improving Gut microbiologY (SYNERGY): a protocol of placebo-controlled randomised cross-over trial Probiotic Amelioration of Azotemia in 5/6th Nephrectomized Sprague-Dawley Rats Effect of short-term synbiotic treatment on plasma p-cresol levels in patients with chronic renal failure: a randomized clinical trial. A Systematic Review of Probiotic Interventions for Gastrointestinal Symptoms and Irritable Bowel Syndrome in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) Effect of pregnancy on gingival inflammation in systemically healthy women: a systematic review. Helicobacter pylori infection in hemodialysis patients: susceptibility to amoxicillin and clarithromycin. Influence of prebiotic and probiotic supplementation on the progression of chronic kidney disease. Effect of increased convective clearance by on-line hemodiafiltration on all cause and cardiovascular mortality in chronic hemodialysis patients – the Dutch CONvective TRAnsport STudy (CONTRAST): rationale and design of a randomised controlled trial [ISRCTN38365125] Effects of a symbiotic on gut microbiota in Mexican patients with end-stage renal disease. Dietary fiber, glycemic index, glycemic load and renal cell carcinoma risk. Effect of probiotics on human blood urea levels in patients with chronic renal failure. Synbiotics Easing Renal Failure by Improving Gut Microbiology (SYNERGY): A Randomized Trial. Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients p-Cresyl sulphate and indoxyl sulphate predict progression of chronic kidney disease Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial. The effect of probiotics on respiratory infections and gastrointestinal symptoms during training in marathon runners. Angiotensin II Type 1 Receptor Antagonist, Losartan, Causes Regression of Left Ventricular Hypertrophy in End-Stage Renal Disease Results from EuCliD® (European Clinical Dialysis Database): Impact of shifting treatment modality Effect of vitamin D supplementation on inflammation: protocol for a systematic review Predictors of heart rate variability and its prognostic significance in chronic kidney disease. The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease. The Effect of High-Flux Hemodialysis on Dialysis-Associated Amyloidosis
Background . Primary goal of this r and omized , double-blind , placebo-controlled crossover study of Renadyl in end-stage renal disease patients was to assess the safety and efficacy of Renadyl measured through improvement in quality of life or reduction in levels of known uremic toxins . Secondary goal was to investigate the effects on several biomarkers of inflammation and oxidative stress . Methods . Two 2-month treatment periods separated by 2-month washout and crossover , with physical examinations , venous blood testing , and quality of life question naires completed at each visit . Data were analyzed with SAS V9.2 . Results . 22 subjects ( 79 % ) completed the study . Observed trends were as follows ( none reaching statistical significance ): decline in WBC count ( −0.51 × 109/L , P = 0.057 ) and reductions in levels of C-reactive protein ( −8.61 mg/L , P = 0.071 ) and total indoxyl glucuronide ( −0.11 mg% , P = 0.058 ) . No statistically significant changes were observed in other uremic toxin levels or measures of QOL . Conclusions . Renadyl appeared to be safe to administer to ESRD patients on hemodialysis . Stability in QOL assessment is an encouraging result for a patient cohort in such advanced stage of kidney disease . Efficacy could not be confirmed definitively , primarily due to small sample size and low statistical power — further studies are warranted Background Emerging evidence suggests modulating the microbiota in the large bowel of patients with chronic kidney disease ( CKD ) through pre- and /probiotic supplementation may inhibit the development of key nephrovascular toxins . To date , quality intervention trials investigating this novel treatment in CKD are lacking . The aim of SYNERGY is to assess the effectiveness of synbiotics ( co-administration of pre- and probiotics ) as a potential treatment targeting the synthesis of uremic toxins , specifically , indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) . Methods / design Thirty-seven patients with moderate to severe CKD ( Stage IV and V , pre-dialysis ) will be recruited to a double-blind , placebo-controlled , r and omised cross-over trial . Patients will be provided with synbiotic therapy or placebo for 6 weeks , with a 4 week washout before cross-over . The primary outcome is serum IS , total and free ( unbound ) concentrations , measured using ultra-performance liquid chromatography . Secondary outcomes include serum PCS , total and free ( unbound ) concentrations ; cardiovascular risk , measured by serum lipopolysaccharides , serum trimethylamine-N-oxide ( TMAO ) and inflammation and oxidative stress markers ; kidney damage , measured by 24 hour proteinuria and albuminuria , estimated glomerular filtration rate and renal tubule damage ( urinary kidney injury molecule-1 ) ; patients ’ self assessed quality of life ; and gastrointestinal symptoms . In addition , the effects on the community structure of the stool microbiota will be explored in a subset of patients to vali date the mechanistic rationale underpinning the synbiotic therapy . Discussion IS and PCS are two novel uremic toxins implicated in both cardiovascular disease ( CVD ) and progression of CKD . Preliminary studies indicate that synbiotic therapy maybe a promising strategy when considering a targeted , tolerable and cost-efficient therapy for lowering serum IS and PCS concentrations . This trial will provide high quality ‘ proof-of-concept ’ data to eluci date both the efficacy of synbiotic therapy for lowering the toxins and whether reductions in serum IS and PCS translate into clinical benefits . Considering the potential of pre- and probiotics to not only shift toxin levels , but to also impede CVD and CKD progression , SYNERGY will provide vital insight into the effectiveness of this innocuous nutritional therapy . Trial Registration Universal Trial Number : U1111 - 1142 - 4363 . Australian New Zeal and Clinical Trials Registry Number : ACTRN12613000493741 , date registered : 2nd May 2013 The present study was to test the hypothesis that selected bacteria instilled into the gastrointestinal tract could help in converting nitrogenous wastes accumulated due to renal insufficiency into nontoxic compounds ; thereby , ameliorating the biochemical imbalance . Herein we describe a prospect i ve , blinded , placebo-controlled pilot study , using 5/6th nephrectomized Sprague Dawley rat as a chronic renal failure model . The study group consisted of 36 nephrectomized and 7 non-nephrectomized ( control ) rats . After two-week nephrectomy stabilization , cohorts of six nephrectomized rats were fed casein-based diet plus one of the following regimens : ( A ) Control , ( B ) Placebo ( casein-based diet without probiotics ) , ( C ) Bacillus pasteurii , ( D ) Sporolac ® , ( E ) Kibow cocktail , ( F ) CHR Hansen Cocktail , and ( G ) ECONORMTM .  Subsequently , blood ( retro-orbital ) and urine ( collected for measurements of blood urea-nitrogen and creatinine respectively ) , body weight and bacterial counts ( feces ) were obtained at regular intervals . The study end-points were to determine if any of the probiotic dietary supplements facilitated , ( 1 ) decreased blood concentrations of uremic toxins , ( 2 ) altered renal function , and ( 3 ) prolonged survival . After 16 weeks of treatment , regimens C and D significantly prolonged the life span of uremic rats , in addition to showing a reduction in blood urea-nitrogen levels , concluding that supplementation of probiotic formulation to uremic rats slows the progression of azotemia , which may correlate with prolonged life span of uremic rats . Derivative trials of probiotic treatment of larger animals and humans will further assess the potential role of probiotic formulations in delaying the onset and clinical severity of clinical illness at different stages of renal failure BACKGROUND AND AIMS In patients with chronic kidney disease ( CKD ) , alterations in gut microbiome are posited to be responsible for gastrointestinal symptoms and generation of p-cresol , a uremic toxin that has been associated with CKD progression and cardiovascular mortality . This pilot study investigated whether Probinul-neutro ® , a synbiotic that normalizes intestinal microflora , may lower plasma p-cresol concentrations and reduce gastrointestinal symptoms in non-dialyzed CKD patients . METHODS AND RESULTS This was a double-blind , r and omized placebo-controlled trial . Thirty patients on 3 - 4 CKD stages were r and omized to receive either Probinul neutro ® or placebo for 4 weeks . Total plasma p-cresol concentration was assessed at baseline , and 15 and 30 days after treatment start . At the same study times , ease and frequency of defecation , upper and lower abdominal pain , stool shape , borborygmi , and flatus were quantified by subjective assessment question naires . Compared to baseline total plasma p-cresol median concentrations on 15th and 30th day were significantly lower in patients receiving Probinul-neutro ® ( 2.31 and 0.78 vs. 3.05 μg/ml , p < 0.05 ; n = 18 ) ; no changes of plasma p-cresol concentrations were recorded in placebo-treated patients . No significant changes in gastrointestinal symptoms were observed during the study both in Probinul-neutro ® -treated and placebo-treated patients . CONCLUSION Probinul-neutro ® lowered total plasma p-cresol concentrations but did not ameliorate gastrointestinal symptoms in non-dialyzed CKD patients . Because high plasma concentrations of p-cresol in early phases of CKD are predictive of progression to end-stage renal disease , the results of our study suggest that synbiotics deserve attention as possible tools to delay CKD progression towards end-stage renal disease ( ESRD ) . CLINICAL TRIALSGOV IDENTIFIER NCT02008331 Gastrointestinal ( GI ) symptoms and irritable bowel ( IB ) symptoms have been associated with chronic fatigue syndrome/myalgic encephalomyelitis ( CFS/ME ) . The aim of this study was to conduct a systematic review of these symptoms in CFS/ME , along with any evidence for probiotics as treatment . Pubmed , Scopus , Medline ( EBSCOHost ) and EMBASE data bases were search ed to source relevant studies for CFS/ME . The review included any studies examining GI symptoms , irritable bowel syndrome ( IBS ) and /or probiotic use . Studies were required to report criteria for CFS/ME and study design , intervention and outcome measures . Quality assessment was also completed to summarise the level of evidence available . A total of 3381 publications were returned using our search terms . Twenty-five studies were included in the review . R and omised control trials were the predominant study type ( n = 24 ) . Most of the studies identified examined the effect of  probiotic supplementation on the improvement of IB symptoms in IBS patients , or IB symptoms in CFS/ME patients , as well as some other significant secondary outcomes ( e.g. quality of life , other gastrointestinal symptoms , psychological symptoms ) . The level of evidence identified for the use of  probiotics  in IBS was excellent in quality ; however , the evidence available for the use of probiotic interventions in CFS/ME was poor and limited . There is currently insufficient evidence for the use of probiotics in CFS/ME patients , despite probiotic interventions being useful in IBS . The studies pertaining to probiotic interventions in CFS/ME patients were limited and of poor quality overall . St and ardisation of protocol s and methodology in these studies is required AIM To obtain an overall quantitative estimate of the association between pregnancy and gingival inflammation . MATERIAL AND METHODS Medline and EMBASE data bases were search ed through August 2011 . Prospect i ve cohort or cross-sectional studies assessing the effect of pregnancy on gingival inflammation evaluated by the gingival index ( GI ) and /or bleeding on probing were included . Meta-analyses were performed if possible . RESULTS Forty-four articles representing 33 studies ( 14 cohort and 19 cross-sectional ) were included . Meta-analyses , performed whenever possible , revealed ( 1 ) a significantly lower GI in pregnant women in the first term compared with those in their second or third term of pregnancy ; ( 2 ) a lower mean GI score in post-partum women compared with women in their second [ WMD = 0.143 ; 95 % CI ( 0.031 ; 0.255 ) ; p = 0.012 ] or third term [ WMD = 0.256 ; 95 % CI ( 0.151 ; 0.360 ) ; p < 0.001 ] of pregnancy , when considering cohort studies ; ( 3 ) Non-pregnant women had lower mean GI values than women in their second or third term of pregnancy . Small changes in plaque levels were reported . CONCLUSION Despite the limited number of studies included in the meta-analyses , the present systematic review confirms the existence of a significant increase in GI throughout pregnancy and between pregnant versus post-partum or non-pregnant women , without a concomitant increase in plaque levels AIM To evaluate susceptibility of Helicobacter pylori to amoxicillin and clarithromycin in end-stage renal disease ( ESRD ) patients and non-uremic controls . METHODS The subjects with dyspeptic complaints were 33 ESRD patients and 46 age- and sex-matched non-uremic controls who exhibited H pylori on antral biopsy specimens . The two groups were age and sex matched . The H pylori strains ' pattern of susceptibility to amoxicillin and clarithromycin was investigated with the agar dilution technique . RESULTS None of the H pylori strains from either group showed resistance to amoxicillin with the agar dilution method . Twelve ( 36.4 % ) of the ESRD group strains and 7 ( 15.2 % ) of the control group strains showed resistance to clarithromycin  , and this difference was statistically significant ( P<0.05 ) . CONCLUSION Resistance to amoxicillin  does not appear to be an important problem in H pylori-infected ESRD and non-uremic patients in our region . In contrast , the rates of resistance to clarithromycin  are high , particularly in the ESRD population BACKGROUND One of the main goals in chronic kidney disease ( CKD ) patients is to diminish the accumulation of uremic toxins and to slow the progression of renal failure . We investigated whether prebiotic and probiotic supplementation along with low protein diet retards the progression of CKD . METHODS This is a 12-month prospect i ve observation study with a r and omized control and open-label design . A total of 24 stable CKD stage III to V patients , who are not on renal replacement therapy , were enrolled in this study . Patients were r and omly assigned to 2 groups : low protein diet + prebiotic + probiotic supplementation ( N.=12 ) , receiving 3 tablets of prebiotic + probiotic supplementation daily for 6 months , and the control group receiving low protein diet only ( N.=12 ) . We examined the effects of prebiotic and probiotic supplementation on estimated glomerular filtration rate ( eGFR ) in CKD . RESULTS The declining GFR  during prebiotic and probiotic supplementation were significantly lower ( -11.6±8.6 vs. -3.4±4.6 mL/min per 1.73 m2 per year , 95 % CI -6.45 - -9.86 , P<0.001 ) than those with low protein diet alone . CONCLUSIONS Prebiotic and probiotic supplementation along with low protein diet delayed the progression of CKD Background The high incidence of cardiovascular disease in patients with end stage renal disease ( ESRD ) is related to the accumulation of uremic toxins in the middle and large-middle molecular weight range . As online hemodiafiltration ( HDF ) removes these molecules more effectively than st and ard hemodialysis ( HD ) , it has been suggested that online HDF improves survival and cardiovascular outcome . Thus far , no conclusive data of HDF on target organ damage and cardiovascular morbidity and mortality are available . Therefore , the CONvective TRAnsport STudy ( CONTRAST ) has been initiated . Methods CONTRAST is a Dutch multi-center r and omised controlled trial . In this trial , approximately 800 chronic hemodialysis patients will be r and omised between online HDF and low-flux HD  , and followed for three years . The primary endpoint is all cause mortality . The main secondary outcome variables are fatal and non-fatal cardiovascular events . Conclusion The study is design ed to provide conclusive evidence whether online HDF leads to a lower mortality and less cardiovascular events as compared to st and ard HD OBJECTIVES Gut microbiota provides beneficial effects under physiological conditions , but is able to contribute to inflammatory diseases in susceptible individuals . Thus , we design ed this study to test whether additional intake of symbiotic gel affects specific modifications of gut microbiota in patients with end-stage renal disease ( ESRD ) . METHODS Eighteen patients with ESRD diagnosis with renal replacement therapy ( hemodialysis ) were included in this study . They were r and omly assigned to 2 treatment groups : ( 1 ) test group ( nutritional counseling + symbiotic ) and ( 2 ) control group ( nutritional counseling + placebo ) . Clinical history and the evaluation of Gastrointestinal Symptom Rating Scale were performed . Gut microbiota composition was analyzed by real-time polymerase chain reaction from fecal sample s. All subjects were followed for 2 months . RESULTS Bifidobacterial counts were higher in the second sample s ( mean : 5.5 ± 1.72 log10 cells/g ) than in first sample s ( 4.2 ± 0.88 log 10 cells/g ) in the patients of the test group ( P = .0344 ) . Also , lactobacilli counts had a little decrease in the test group ( 2.3 ± 0.75 to 2.0 ± 0.88 log 10 cells/g ) and the control group ( 2.2 ± 0.90 to 1.8 ± 1.33 log 10 cells/g ) , between the first and the second sample s. Gastrointestinal symptoms scores ( scale 8 - 40 ) were reduced in the test group ( start 12 [ 10 - 14 ] and end 9 [ 8 - 10 ] ) compared with control group ( start 11 [ 8 - 21 ] and end 11 [ 9 - 15 ] ) . CONCLUSIONS Short-term symbiotic treatment in patients with ESRD can lead to the increase of Bifidobacterium counts , maintaining the intestinal microbial balance Several epidemiological studies have investigated the potential association between dietary fiber , glycemic index ( GI ) or glycemic load ( GL ) , and renal cell carcinoma ( RCC ) risk with inconsistent results . The aim of this study was to systematic ally evaluate this issue with a meta- analysis approach . A comprehensive literature search up to March 2018 was performed in PubMed and Web of Science data bases . Summary relative risks ( RRs ) and 95 % confidence intervals ( CIs ) were estimated with a r and om-effects model . Twelve studies were finally included in this study ( eight for fiber analysis , five for GI and five for GL ) . A significant positive association was observed between GI and the risk of RCC ( summary RR 1.16 , 95 % CI 1.02 - 1.32 ) , and no significant heterogeneity was detected among studies ( I2 = 22.8 % , P = 0.262 ) . A significant inverse association was found between fiber intake and the risk of RCC ( summary RR 0.82 , 95 % CI 0.72 - 0.92 ) , and no significant heterogeneity was observed across studies ( I2 = 27.6 % , P = 0.218 ) . GL was not significantly associated with RCC risk ( summary RR 1.14 , 95 % CI 0.81 - 1.60 ) , and significant heterogeneity was found across studies ( I2 = 78.6 % , P < 0.001 ) . In conclusion , this systematic review and meta- analysis suggests that dietary GI and fiber may be associated with the risk of RCC . Further large prospect i ve cohort studies are still warranted to confirm our preliminary findings INTRODUCTION Patients with chronic kidney disease ( CKD ) show an increase in bowel aerobic bacteria that produce uremic toxins and decreased anaerobic bacteria as bifidobacteria and lactobacillus . The latter can be used as probiotics . The probiotic with greater availability in Mexico , is the lactobacillus casei shirota ( LcS ) , currently there is no known LcS specified dose that produces a benefit to the patient with CKD . OBJECTIVE To determine the effectiveness of two different LcS doses in achieving a decrease in urea concentrations of at least 10 % in patients with KDOQI stage 3 and stage 4 CKD . METODOLOGY : A simple r and omized , controlled clinical trial . Out patients treated at the National Institute of Medical Sciences and Nutrition Salvador Zubirán in México D.F. Patients were provided the LcS , as follows : Group A : 8 x 10(9 ) colony-forming units ( CFU ) and Group B : 16 x 10(9 ) CFU . Patients were followed-up for eight weeks , and baseline and final sample s were obtained to calculate the basal and final concentrations , respectively , of blood urea and serum creatinine ( CrS ) . During the follow-up , both groups consumed a diet of 30 kcal/kg/weight and 0.8 g/kg/weight of protein , and a food diary was made to assess both the adherence to the diet  and  LcS.  RESULTS Thirty patients with CKD were evaluated . When analyzing the percentage change between the different doses , a decrease > 10 % was found in the blood urea concentrations for patients treated with the 16 x 109 dose , which was significant with respect to the baseline measurement . CONCLUSION There was a > 10 % decrease in the serum urea concentrations with LcS in patients with stage 3 and 4 CRF BACKGROUND AND OBJECTIVES The generation of key uremic nephrovascular toxins , indoxyl sulfate ( IS ) , and p-cresyl sulfate ( PCS ) , is attributed to the dysbiotic gut microbiota in CKD . The aim of our study was to evaluate whether synbiotic ( pre- and probiotic ) therapy alters the gut microbiota and reduces serum concentrations of microbiome-generated uremic toxins , IS and PCS , in patients with CKD . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Predialysis adult participants with CKD ( eGFR=10 - 30 ml/min per 1.73 m(2 ) ) were recruited between January 5 , 2013 and November 12 , 2013 to a r and omized , double-blind , placebo-controlled , crossover trial of synbiotic therapy over 6 weeks ( 4-week washout ) . The primary outcome was serum IS . Secondary outcomes included serum PCS , stool microbiota profile , eGFR , proteinuria-albuminuria , urinary kidney injury molecule-1 , serum inflammatory biomarkers ( IL-1β , IL-6 , IL-10 , and TNF-α ) , serum oxidative stress biomarkers ( F2-isoprostanes and glutathione peroxidase ) , serum LPS , patient-reported health , Gastrointestinal Symptom Score , and dietary intake . A prespecified subgroup analysis explored the effect of antibiotic use on treatment effect . RESULTS Of 37 individuals r and omized ( age = 69±10 years old ; 57 % men ; eGFR=24±8 ml/min per 1.73 m(2 ) ) , 31 completed the study .  Synbiotic therapy did not significantly reduce serum IS ( -2 μmol/L ; 95 % confidence interval [ 95 % CI ] , -5 to 1 μmol/L ) but did significantly reduce serum PCS ( -14 μmol/L ; 95 % CI , -27 to -2 μmol/L ) . Decreases in both PCS and IS concentrations were more pronounced in patients who did not receive antibiotics during the study ( n=21 ; serum PCS , -25 μmol/L ; 95 % CI , -38 to -12 μmol/L ; serum IS , -5 μmol/L ; 95 % CI , -8 to -1 μmol/L ) . Synbiotics also altered the stool microbiome , particularly with enrichment of Bifidobacterium and depletion of Ruminococcaceae . Except for an increase in albuminuria of 38 mg/24 h ( P=0.03 ) in the synbiotic arm , no changes were observed in the other secondary outcomes . CONCLUSION In patients with CKD , synbiotics did not significantly reduce serum IS but did decrease serum PCS and favorably modified the stool microbiome . Large-scale clinical trials are justified OBJECTIVES Psychological treatment of depression in end-stage renal disease ( ESRD ) has focused on severely depressed patients . We design ed and tested a brief ( 5 weeks ) cognitive behavioural intervention ( CBI ) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD . DESIGN For the purpose of this study , a single-blind , r and omized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI .  METHODS Depression and anxiety symptoms were screened in 152 subjects ( 18 - 60 years old , 84 male ) . Sixty participants ( age 41.8 ± 14.7 , 29 males ) with mild or moderate scores of depression ( Beck Depression Inventory ) and anxiety ( Beck Anxiety Inventory ) were r and omly assigned to CBI or the control group . CBI techniques consisted of positive self-reinforcement , deep breathing , muscle relaxation , and cognitive restructuring . Depression , anxiety , quality of life ( QoL ) , and cognitive distortion scores were evaluated at baseline , after 5 weeks ( end of treatment ) and after 4-week follow-up . All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni 's method ( p < .05 was considered significant ) . RESULTS At follow-up , depression , anxiety , and cognitive distortions had decreased , and QoL had increased in the intervention group , and there were no changes in the control group . Clinical utility was 33 % for depression and 43 % for anxiety . CONCLUSIONS A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients . PRACTITIONER POINTS A brief , systematic and structured cognitive behavioural intervention ( CBI )  decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease ( ESRD ) who are being treated with haemodialysis . These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically . This CBI consisted of cognitive restructuring of the distorted thoughts ( perfectionism , catastrophic thinking , negative self-labelling , and dichotomous thinking ) that are correlated with depression and anxiety symptoms and that can be assessed by a vali date d question naire design ed for patients with ESRD . The h and books that were developed for this study are structured and systematic . They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses , physicians , social workers , and psychologists , raising the possibility of further application in a variety of clinical population s. Both the therapy and the client workbooks are available in Spanish upon request Background . Indoxyl sulphate ( IS ) and p-cresyl sulphate ( PCS ) are uraemic toxins that have similar protein binding , dialytic clearance and proinflammatory features . However , only a few prospect i ve studies have evaluated possible associations between these two retained solutes and renal disease progression in chronic kidney disease ( CKD ) patients . Methods . This prospect i ve observational study evaluated independent associations between serum total IS and PCS with renal progression in a selected cohort of patients having different stages of CKD .  Baseline PCS and IS were correlated with renal progression [ defined as decrements in estimated glomerular filtration rate ( eGFR ) > 50 % from baseline or progression to end-stage renal disease ( ESRD ) ] and death during a follow-up period of 24 months . Results . Of 268 patients , 35 ( 13.1 % ) had renal progression and 14 ( 5.2 % ) died  after a mean follow-up of 21 ± 3 months . Univariate Cox regression analysis followed by multivariate analysis showed that high-serum PCS levels were associated with renal progression and all-cause mortality independent of age , gender , diabetes status , albumin levels , serum IS , serum creatinine , Ca × P product , intact parathyroid hormone , haemoglobin or high-sensitivity C-reactive protein level . Serum IS was only associated with renal progression ; however , the predictive power of serum IS was weakened when serum PCS was also present in the analytical model . Conclusions . In addition to traditional and uraemia-related risk factors such as renal function , serum IS and PCS levels may help in predicting the risk of renal progression in patients having different stages of CKD OBJECTIVE The objective of the study was to evaluate the effects of probiotic supplementation on the gut microbiota profile and inflammatory markers in chronic kidney disease patients undergoing maintenance hemodialysis ( HD ) . DESIGN AND METHODS This was a r and omized , double-blind , placebo-controlled study . Forty-six HD patients were assigned to receive 1 of 2 treatments : probiotic ( n = 23 ; Streptococcus thermophilus , Lactobacillus acidophilus e Bifidobacterialongum , 90 billion colony-forming units per day ) or placebo ( n = 23 ) daily for 3 months . Blood and feces were collected at baseline and after intervention . The inflammatory markers ( C-reactive protein and interleukin-6 ) were analyzed by immunoenzymatic assay ( enzyme-linked immunosorbent assay ) . Uremic toxins plasma levels ( indoxyl sulfate , p-cresyl sulfate , and indole-3-acetic acid ) were obtained by Reversed-Phase High-Performance Liquid Chromatography . Routine laboratory parameters were measured by st and ard techniques . Fecal pH was measured by the colorimetric method , and the gut microbiota profile was assessed by Denaturing Gradient Gel Electrophoresis analysis . RESULTS Sixteen patients remained in the probiotic group ( 11 men , 53.6 ± 11.0 year old , 25.3 ± 4.6 kg/m2 ) and 17 in the placebo group ( 10 men , 50.3 ± 8.5 year old , 25.2 ± 5.7 kg/m2 ) . After probiotic supplementation there was a significant increase in serum urea ( from 149.6 ± 34.2 mg/dL to 172.6 ± 45.0 mg/dL , P = .02 ) , potassium ( from 4.4 ± 0.4 mmol/L to 4.8 ± 0.4 mmol/L , P = .02 ) , and indoxyl sulfate ( from 31.2 ± 15.9 to 36.5 ± 15.0 mg/dL , P = .02 ) . The fecal pH was reduced from 7.2 ± 0.8 to 6.5 ± 0.5 ( P = .01 ) . These parameters did not change significantly in placebo group . Changes in the percentage delta ( Δ ) between groups were exhibited with no statistical differences observed . The inflammatory markers and gut profile were not altered by supplementation . CONCLUSIONS Aprobiotic supplementation failed to reduce uremic toxins and inflammatory markers . Therefore , probiotic therapy should be chosen with caution in HD patients . Further studies addressing probiotic therapy in chronic kidney disease patients are needed Heavy exercise is associated with an increased risk of upper respiratory tract infections . Strenuous exercise also causes gastrointestinal ( GI ) symptoms . In previous studies probiotics have reduced respiratory tract infections and GI symptoms in general population s including children , adults , and the elderly . These questions have not been studied in athletes before . The purpose of this study was to investigate the effect of probiotics on the number of healthy days , respiratory infections , and GI-symptom episodes in marathon runners in the summer . Marathon runners ( N = 141 ) were recruited for a r and omized , double-blind intervention study during which they received Lactobacillus rhamnosus GG ( LGG ) or placebo for a 3-mo training period . At the end of the training period the subjects took part in a marathon race , after which they were followed up for 2 wk . The mean number of healthy days was 79.0 in the LGG group and 73.4 in the placebo group ( P = 0.82 ) . There were no differences in the number of respiratory infections or GI-symptom episodes . The duration of GI-symptom episodes in the LGG group was 2.9 vs. 4.3 d in the placebo group during the training period ( P = 0.35 ) and 1.0 vs. 2.3 d , respectively , during the 2 wk after the marathon ( P = 0.046 ) . LGG had no effect on the incidence of respiratory infections or GI-symptom episodes in marathon runners , but it seemed to shorten the duration of GI-symptom episodes Left ventricular hypertrophy ( LVH ) commonly occurs in patients with end-stage renal disease ( ESRD ) and is an independent risk factor for cardiovascular events . Angiotensin II type 1 receptor ( AT1-R ) antagonists may be able to reverse LVH independent to the hypotensive effect in the ESRD setting . Thirty chronically hemodialyzed uremic patients with hypertension were r and omly assigned to receive the AT1-R antagonist losartan ( n = 10 ) , the angiotensin-converting enzyme ( ACD ) inhibitor enalapril ( n = 10 ) , or calcium antagonist amlodipine ( n = 10 ) . Left ventricular mass ( LVM ) index was measured by echocardiography before and 6 months after treatment . The baseline demographic and clinical characteristics did not differ between the three groups . The mean baseline LVM index also did not differ in the three groups . After 6 months of treatment , losartan treatment significantly reduced the LVM index ( –24.7 ± 3.2 % ) than amlodipine ( –10.5 ± 5.2 % ) or enalapril ( –11.2 ± 4.1 % ) therapy . All three groups had a similar decrease in the mean blood pressure with treatment . The plasma angiotensin II concentration increased 5-fold with losartan treatment . In contrast , the plasma angiotension II concentration did not change with enalapril and only increased 2-fold with amlodipine . Thus , the present study indicates that losartan more effectively regresses LVH in patients with ESRD than do enalapril and amlodipine despite a comparable depressor effect between the three drugs Background : The use of biocompatible high-flux membranes is more efficient than low-flux membranes in controlling a number of hemodialysis-related diseases . The aim of this cooperative study was to evaluate the 6-month effect of a switch from low- to high-flux dialysers  on patients treated in 39 Spanish dialysis centres . Methods : The clinical data used in this analysis were prospect ively collected by the EuCliD ® data base , developed to monitor the quality of treatment delivered in a large network of European Dialysis Centres . Inclusion criteria for the study were the condition of end-stage renal disease ( ESRD ) on chronic hemodialysis and low-flux dialysis for at least six months before the switch to high-flux dialysis . Of 1,543 patients enrolled in the study between 2000 and 2001 , 1,046 patients were considered for the analysis . 497 patients were excluded because they did not complete the follow-up . Outcome measures were the reduction of pre-dialysis beta-2 microglobulin , the improvement of anemia or reduction in rHu-EPO dose required to maintain best correction of anemia , reduction of inflammatory parameters ( CRP ) , improvement in lipid profile ( Total and HDL cholesterol , tryglycerides ) , maintenance of nutritional status . Albumin and “ dry ” ( post-hemodialysis ) body weight were both evaluated as nutritional indexes . Results : During the six months of high-flux hemodialysis , there was a significant increase in hemoglobin ( from 11.55±1.41 to 11.88±1.43 g/L ; p<0.001 ) . Considering the temporarily untreated patients on a 0 U/week dose , erythropoietin remained stable ( from 5,670±4,199 to 5,657±4,411 U/week ) . During the second part of the follow-up , the lipid profile significantly improved ( Fig. 3 ) . Total cholesterol and triglycerides decreased significantly ( p<0.001 ) , while HDL cholesterol increased ( p=0.006 ) . Calculated levels of LDL cholesterol also significantly decreased ( p=0.001 ) . Dry body weight remained stable ( 64.7±11.9 vs. 64.7±12.0 kg ) as well as in albumin levels ( 3.93±0.43 vs. 3.94±0.43 g/dL ) between the two modalities of treatment . The level of ß2-microglobulin significantly decreased during high-flux dialysis ( 33.5±14.4 vs. 26.3±8.6 mg/dL , p<0.001 ) . Conclusion : All above mentioned results may have as a common denominator an improved blood purification from uremic toxins and a reduced level of chronic sub- clinical inflammation . All together , these results seem to confirm the superiority of high-flux dialysis in terms of clinical and physiological outcomes Introduction The extraskeletal role of vitamin D is being increasingly recognised . This has important clinical implication s , as vitamin D deficiency has reached epidemic proportions worldwide . Vitamin D has proposed anti-inflammatory properties , yet the role of vitamin D supplementation in reducing inflammation remains largely unknown . The purpose of this review is to investigate the impact of vitamin D supplementation on inflammation , and to identify relevant knowledge gaps in the field . Methods and analysis Medline , CINAHL , EMBASE and All EBM will be systematic ally search ed for r and omised controlled trials ( RCTs ) and systematic review s of RCTs , comparing vitamin D supplementation with placebo , usual care or other pharmacological or non-pharmacological interventions . One review er will assess articles for eligibility according to prespecified selection criteria , after which 2 independent review ers will perform data extraction and quality appraisal . Meta-analyses will be conducted where appropriate . Ethics and dissemination Formal ethical approval is not required as no primary data is collected . This systematic review will identify potential clinical implication s of vitamin D deficiency and supplementation , and will be disseminated through a peer- review ed publication and at conference meetings , to inform future research on the efficacy of vitamin D supplementation for inflammation and inflammatory diseases . PROSPERO registration number CRD42016037104 BACKGROUND Heart rate variability ( HRV ) , a noninvasive measure of autonomic dysfunction and a risk factor for cardiovascular disease ( CVD ) , has not been systematic ally studied in nondialysis chronic kidney disease ( CKD ) . METHODS HRV was assessed using 24-h Holter monitoring in 305 subjects from the Renal Research Institute-CKD Study , a four-center prospect i ve cohort of CKD ( Stages 3 - 5 ) .  Multiple linear regression was used to assess predictors of HRV ( both time and frequency domain ) and Cox regression used to predict outcomes of CVD , composite of CVD/death and end-stage renal disease ( ESRD ) . RESULTS A total of 47 CVD , 67 ESRD and 24 death events occurred over a median follow-up of 2.7 years . Lower HRV was significantly associated with older age , female gender , diabetes , higher heart rate , C-reactive protein and phosphorus , lower serum albumin and Stage 5 CKD . Lower HRV ( mostly frequency domain ) was significantly associated with higher risk of CVD and the composite end point of CVD or death . Significantly , lower HRV ( frequency domain ) was associated with higher risk of progression to ESRD , although this effect was relatively weaker . CONCLUSIONS This study draws attention to the importance of HRV as a relatively under recognized predictor of adverse cardiovascular and renal outcomes in patients with nondialysis CKD . Whether interventions that improve HRV will improve these outcomes in this high-risk population deserves further study AIM To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease ( ESRD ) patients on renal replacement therapy ( RRT ) .  METHODS In a prospect i ve fashion , symptoms of depression were evaluated in ESRD patients on RRT  using the depression subscore of the Hospital Anxiety and Depression Scale ( HADS ) . Fatal and non-fatal clinical events were determined during a 1-year follow-up . RESULTS Of 101 patients with ESRD , 42 % showed manifest depressive symptoms , defined as a HADS-D score > or = 7 . No association was found between depressive symptoms and severity of somatic disease . During follow-up , all-cause mortality was significantly higher in patients with depressive symptoms above threshold ( n = 42 , mortality : 26 % ) compared to patients with depressive symptoms below threshold ( n = 59 , mortality 8 % ) , ( crude HR 3.3 , CI 1.2 - 9.6 , P = 0.02 ) . The excess in mortality was mainly caused by a higher incidence of septicaemia ( 0 versus 12 % , P = 0.01 ) . After adjustment for clinical parameters , this association between depressive symptoms and mortality became even stronger . There was no significant difference observed in the incidence of cardiovascular events . CONCLUSIONS Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival . Future research should address appropriate therapeutic regimens Amyloidosis is an important cause of mortality and morbidity in patients with end-stage renal disease ( ESRD ) undergoing hemodialysis ( HD ) .  In this study , depending on the idea that the clearance of middle and high molecular weight toxins could be improved , we aim ed to investigate the effect of high-flux dialyzer on clearance of beta-2 microglobulin ( β2-MG ) and calcium ( Ca ) phosphorus ( P ) metabolism in patients under HD treatment . Forty-eight patients with ESRD under chronic HD treatment were included in the study . All patients were r and omized into two groups , and HD was performed with low-flux or high-flux dialyzer for 6 months . In the high-flux group , the reduction of β2-MG and P levels during dialysis was significantly higher when compared with the low-flux group ( p < 0.001 ) . During the follow-up period , while β2-MG levels decreased significantly in the high-flux group ( p < 0.05 ) , there was an increase in the low-flux group ( p < 0.05 ) . As a result , our findings suggest that use of high-flux dialyzer can be an efficient alternative in terms of controlling the clearance of β2-MG and impaired Ca and P metabolism . These beneficial effects of high-flux dialyzers are probably mediated by the improved clearance of middle and high molecular weight toxins
Conclusion Our study demonstrates potential beneficial effects of probiotics on inflammation , uremic toxins , and GI Symptoms in ESRD patients .
Background / Objectives We performed this systematic review and meta- analysis to evaluate effects of probiotics on inflammation , uremic toxins , and gastrointestinal ( GI ) symptoms in end-stage renal disease ( ESRD ) patients .