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      The effects of probiotic supplement on hemoglobin in chronic renal failure patients under hemodialysis: A randomized clinical trial

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          Abstract

          Background:

          Chronic inflammation is one of the causes of anemia in chronic renal failure patients under hemodialysis. Probiotics probably establish a balance between pro- and anti-inflammatory cytokines. The study was conducted to determine the effects of probiotic supplementation on hemoglobin (Hb) in hemodialysis patients.

          Materials and Methods:

          A parallel clinical trial was conducted in which patients were randomly allocated into two groups. The intervention group ( n = 18) was given a 500 mg probiotic supplement (a capsule) every day whereas the control group ( n = 18) received placebo (a capsule), both for 3 months. Hb levels and C-reactive protein (CRP) levels were measured for three periods. The data were analyzed in SPSS-16 using statistical tests including the t-test and repeated-measures ANOVA.

          Results:

          In the probiotic supplementation group, the mean Hb was 9.22 ± 1.04 mg/dl before the intervention and reached 10.85 ± 1.177 mg/dl afterward, while in the placebo group, the mean Hb level was 9.38 ± 0.97 mg/dl before the intervention and reached 10.03 ± 1.97 mg/dl afterward ( P > 0.05). During the study, the placebo caused to increase of Hb temporary, but in longer term, the effect of probiotic was more manifested. Hb levels increased in both groups although the change was not statistically significant ( P > 0.05). The findings showed no significant differences between the two groups in either the pre- or post-intervention CRP levels ( P = 0.239).

          Conclusion:

          Probiotic supplementation decreased Hb fluctuations in hemodialysis patients but did not result in a significant increase in Hb levels. Similar studies are therefore recommended to be conducted with a prolonged duration of the study or an increased probiotic dose with larger sample size to complete the results of the present study.

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          Most cited references31

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          Inhibition of prolyl hydroxylases increases erythropoietin production in ESRD.

          The reasons for inadequate production of erythropoietin (EPO) in patients with ESRD are poorly understood. A better understanding of EPO regulation, namely oxygen-dependent hydroxylation of the hypoxia-inducible transcription factor (HIF), may enable targeted pharmacological intervention. Here, we tested the ability of fibrotic kidneys and extrarenal tissues to produce EPO. In this phase 1 study, we used an orally active prolyl-hydroxylase inhibitor, FG-2216, to stabilize HIF independent of oxygen availability in 12 hemodialysis (HD) patients, six of whom were anephric, and in six healthy volunteers. FG-2216 increased plasma EPO levels 30.8-fold in HD patients with kidneys, 14.5-fold in anephric HD patients, and 12.7-fold in healthy volunteers. These data demonstrate that pharmacologic manipulation of the HIF system can stimulate endogenous EPO production. Furthermore, the data indicate that deranged oxygen sensing--not a loss of EPO production capacity--causes renal anemia.
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            Revised European best practice guidelines for the management of anaemia in patients with chronic renal failure.

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              Anaemia management and mortality risk in chronic kidney disease.

              Renal anaemia is a frequent complication in patients with chronic kidney disease (CKD). Severe anaemia (haemoglobin <90 g/l) is associated with increased risks of mortality and cardiac complications, such as left ventricular hypertrophy and cardiovascular disease, and impaired quality of life. Randomized controlled trials have tested the hypothesis that increasing haemoglobin level using erythropoiesis-stimulating agents (ESAs) lowers these risks and improves quality of life. Use of ESAs to normalize haemoglobin levels (to ≥130 g/l) versus the partial correction of anaemia (to haemoglobin levels of 90-110 g/l) has repeatedly been shown to have no cardiac benefit and to be associated with no incremental improvement in outcomes and quality of life (except fatigue), but has been shown to be associated with an increased risk of cardiovascular events and death. Use of more-intense iron dosing has been proposed in order to reduce ESA dosing but liberal intravenous iron therapy is also associated with complications, and its long-term safety has not yet been adequately investigated. For patients with CKD on dialysis, US medication labels recommend administering ESAs at doses sufficient to avoid transfusions, whereas European and Canadian labels recommend targeting haemoglobin levels of 100-120 g/l and 110-120 g/l, respectively. Treatment of anaemia to haemoglobin levels of 90-110 g/l in patients with CKD accomplishes what we want--a reduced need for transfusions and possible reductions in fatigue, while avoiding high doses of ESA or iron in order to achieve a specific haemoglobin goal.
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                Author and article information

                Journal
                J Res Med Sci
                J Res Med Sci
                JRMS
                Journal of Research in Medical Sciences : The Official Journal of Isfahan University of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                1735-1995
                1735-7136
                2017
                21 June 2017
                : 22
                : 74
                Affiliations
                [1]Department of Nephrology, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
                [1 ]Nursing Research Center, Health Management and Social Development Research Center, Golestan University of Medical Sciences, Gorgan, Iran
                [2 ]Department of Nephrology, 5 th Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
                [3 ]Department of Nephrology, Shahroud University of Medical Sciences, Shahroud, Iran
                [4 ]Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
                Author notes
                Address for correspondence: Dr. Gholam Reza Mahmoodi Shan, Golestan University of Medical Sciences, Km 4 Gorgan-Sari Road (Shastcola), P.O. Box 4934174515, Gorgan, Iran. E-mail: mahmoodigh@ 123456yahoo.com
                Article
                JRMS-22-74
                10.4103/jrms.JRMS_614_16
                5508504
                3d878309-46b1-416c-9237-ffa3a98d8cfe
                Copyright: © 2017 Journal of Research in Medical Sciences

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 01 August 2016
                : 10 December 2016
                : 11 March 2017
                Categories
                Original Article

                Medicine
                chronic renal failure,hemodialysis,hemoglobin,probiotic
                Medicine
                chronic renal failure, hemodialysis, hemoglobin, probiotic

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