Effect of Lactobacillus Rhamnosus on serum uremic toxins (phenol and P-Cresol) in hemodialysis patients: A double blind randomized clinical trial.

BACKGROUND: Uremic toxins such as p-cresol and phenol are suggested to be associated with higher mortality in hemodialysis patients. The aim of this study was to investigate the effects of probiotics on some serum uremic toxin levels in hemodialysis patients. METHODS: Patients undergoing hemodialysis in a university dialysis center were enrolled in this randomized controlled double blind clinical trial. The patients received probiotic (Lactobacillus Rhamnosus) for duration of 4 weeks. All data were presented as the mean ± SD. Statistical analyses were performed by SPSS statistical software. Paired t-test was used to compare pre- and post-treatment p-cresol levels. P values less than .05 were considered statistically significant. RESULTS: A total of 42 hemodialysis patients (32 male and 10 female) were enrolled in this study. The mean ± SD age of the patients in Lactobacillus Rhamnosus and placebo groups were 57.05 ± 13.96 and 59.67 ± 15.04 years, respectively. Values of uremic toxins before treatment did not differ statistically between groups but they were significantly lower in Lactobacillus Rhamnosus group compared with placebo group (P < .05). Total Phenol and p-cresol levels were associated with sodium, energy, carbohydrate, fat and protein intake and fiber consumption, accompanying by hemodialysis hours per week in linear regression analyses. CONCLUSIONS: This study demonstrated that probiotics could be a promising target in hemodialysis patients with the capability of decreasing serum phenolic uremic toxins in this population. TRIAL REGISTRATION: IRCT20154182017N21 Date:09/12/2016.

The appropriate dose of thymoglobulin induction therapy in kidney transplantation.

BACKGROUND: Thymoglobulin is used effectively as an induction agent in kidney transplantation, but there is no consensus on the optimal dose. In order to delineate the safest effective dose, an open-labeled randomized clinical trial was designed. METHODS: In this study, 90 adult kidney transplant recipients (KTR) were randomized before transplantation in three groups to receive thymoglobulin: Arm A (4.5 mg/kg in 3 days), Arm B (4.5 mg/kg single bolus dose), and Arm C (6 mg/kg in 3 days). Renal function, infections, and rate of readmissions were evaluated during the first post transplantation year. RESULTS: Ninety adult kidney recipients were enrolled (51% deceased donor). No significant statistical difference was found in acute rejection episodes or type of rejection between these groups, although patients in Arm A showed more severe histopathologic changes according to Banff 2013 criteria, in renal biopsies (P=.03). At the first month after transplantation serum Cr was lower (P=.001) and GFR was higher (P=.04) in Arm A, but there was no significant difference among the three groups at 3, 6, and 12 months post-transplant. CONCLUSION: Although all regimens showed the same efficacy regarding the rate of rejection episodes, 3-day 4.5 mg/kg Thymoglobulin had significantly fewer complications.

Evaluation of Curcumin's effect on inflammation in hemodialysis patients.

OBJECTIVE: Despite advances in prevention of inflammatory milieu with different anti-inflammatory modalities in hemodialysis patients the rate of inflammatory markers in this population are still high. Inflammation is considered as a major player in uremia associated with morbidity and mortality in hemodialysis patients. The aim of this study was to evaluate the turmeric s effects on reduction of inflammatory markers in hemodialysis patients. METHODS: Hemodialysis patients over 18 years were recruited after fulfilling the inclusion criteria. Seventy-one hemodialysis patients were randomized into two groups: the trial group (n = 35) and the controls (n = 36); a randomization numeric table was used for allocation sequence. Trial group received turmeric and control group received placebo for 12 weeks. Biochemical determinations included levels of serum albumin (Alb), potassium (K), blood urea nitrogen (BUN), serum creatinine (Cr), IL-6 level, TNF-α, and liver function tests and hs-CRP at the start and end of the study were measured. RESULTS: Although there was a significant reduction in hs-CRP level, IL-6 level and TNF-α level in turmeric group (p = 0.002, p = 0.001, p = 0.001), there was no statistical difference between intervention and control groups. Albumin level was significantly increased in turmeric group (p = 0.001) and no meaningful changes were seen in potassium or liver function tests neither within nor between groups. CONCLUSION: Programmed ingestion of turmeric has no adverse effects and reduces plasma level of hs-CRP, IL-6 and TNF-α accompanying with increases albumin levels in hemodialysis patients. Turmeric can be considered as an effective anti-inflammatory supplement in hemodialysis patients.