Probiotics affect biomarkers indicative of bone formation, such as alkaline phosphatase (ALP), calcium status, bone mineralization, bone turnover markers and metabolism. This study aims to investigate the effects of synbiotic on gastrointestinal (GI) disorder, bone complications and anemia in hemodialysis (HD) patients. In this randomized, double-blind, placebo-controlled clinical trial study, HD patients received 2 symbiotic (n = 19) or placebo (n = 17) capsules daily for 12 weeks. GI function, serum levels of bone-specific biomarkers, and serum levels of anemia-specific biomarkers were assessed at the beginning and the end of study. GI function was assessed with gastrointestinal symptom rating scale questionnaire. The data were analyzed using SPSS. At the end of this study, parathyroid hormone levels decreased significantly in the synbiotic group (p = 0.039); however, in comparison to placebo group, the difference was not significant. Decrease of ALP levels in the synbiotic group were not statistically significant. However, a significant difference was seen between the 2 groups at the end of intervention (p = 0.037). Improvement in GI symptoms was observed in both groups, but the reduction rate was higher in the synbiotic group. Additionally, at the end of the study, a significant difference between the 2 groups was observed (p < 0.05). No statistically significant difference was observed in the levels of other factors within each group and between the 2 groups (p > 0.05). Symbiotic supplements after 12 weeks led to an improvement in GI function and ALP levels in HD patients. Further investigation into bone-mineral disorders in HD patients is necessary.
Iranian Registry of Clinical Trials Identifier:
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Protein-energy wasting (PEW) is prevalent among hemodialysis (HD) patients and is associated with poor outcomes. There are various methods for nutritional status evaluation in HD patients. Each method has its own advantages and disadvantages. We aimed at comparing the method validities of normalized protein catabolic ratio (nPCR) and malnutrition universal screening tool (MUST) with subjective global assessment (SGA) in HD patients. We examined 88 HD patients using SGA and MUST questionnaires. The nPCRs were calculated using pre-dialysis and post-dialysis BUN and Kt/v. Also, PEW of patients was assessed based on the criteria of the International Society of Renal Nutrition and Metabolism. Methods' specificity, sensitivity, and precision rates were assessed. Correlations between methods were analyzed using Pearson-correlation. Based on the SGA, MUST, and nPCR methods, almost 41%, 30%, and 60% of patients had malnutrition, respectively. According to the criteria, more than 90% of patients had PEW. SGA was positively and significantly associated with MUST (p ≤ 0.001). Sensitivity for SGA, MUST, and nPCR methods were 100%,100%, 1.8%, and their specificity were 98%, 98%, and 4%, and their precision rates were 99.7%, 98.7%, and 3%, respectively. From various methods of nutritional assessment (SGA, MUST, and nPCR), compared to SGA as the common method of nutrition assessment in hemodialysis patients, MUST had the nearest specificity, sensitivity, and precision rate and nPCR method had the lowest ones. nPCR seems to be a flawed marker of malnutrition and it should be more investigated if MUST can be used instead of SGA.
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