Lactulose vs Lactobacillus acidophilus for patients with chronic kidney disease: A randomized controlled trial

Chronic kidney disease (CKD) is associated with progressive accumulation of uremic toxins and chronic systemic inflammation. CKD management focuses on treating the underlying disease, controlling risk factors, slowing disease progression, and initiating renal replacement therapy in stage 5. Early CKD is often asymptomatic or presents with mild symptoms such as fatigue and nocturia, whereas symptoms become progressively more severe after stage 3 and worsen further with renal failure. Modulation of the gut microbiota using prebiotics or probiotics has emerged as a promising adjunctive therapeutic strategy. Lactulose, a non-absorbable disaccharide, and Lactobacillus acidophilus (LA), a probiotic, are commonly used to target gut-derived uremic toxins.

To compare the effects of lactulose and LA on renal functions, inflammatory markers, and gastrointestinal symptoms in patients with non-dialysis CKD.

This prospective comparative study was done on a total of 150 patients with non-dialysis CKD stage 3-5 who were randomly subdivided into three groups: The lactulose group included 50 patients with non-dialysis CKD stage 3-5 who received lactulose 30 mL per day divided into 3 doses; the LA group included 50 patients with non-dialysis CKD stage 3-5 who received one tablet of LA twice daily; and group C included 50 patients with non-dialysis CKD stage 3-5 who didn't receive lactulose or LA. Baseline clinical and laboratory parameters were recorded. Renal function tests (serum creatinine and blood urea), inflammatory markers, and gastrointestinal symptoms were assessed before and after the intervention period.

A total of 150 patients with non-dialysis CKD stages 3-5 were enrolled and equally randomized into three groups: Lactulose (n = 50), LA (n = 50), and control (n = 50). The three groups were comparable in terms of age, sex distribution, body mass index, smoking status, comorbidities, and CKD stage at baseline. Baseline laboratory parameters showed no significant differences among the groups. At the end of the 3-month follow-up period, the LA group achieved the greatest improvement in renal function parameters, as reflected by significantly larger reductions in delta levels of blood urea and serum creatinine compared with both the lactulose and control groups. The mean change in blood urea was -12.45 ± 3.01 mg/dL in the LA group, -5.00 ± 2.45 mg/dL in the lactulose group, and -1.79 ± 3.01 mg/dL in the controls (P = 0.03). Similarly, the mean change in serum creatinine was -20.01% ± 3.45% in the LA group, but -7.33% ± 2.88% in the lactulose group and -6.55% ± 2.44% in the controls (P < 0.001). Improvements in albumin-to-creatinine ratio and estimated glomerular filtration rate were observed in all groups but did not reach statistical significance.

Both lactulose and LA demonstrated beneficial effects in non-dialysis CKD patients. However, LA showed superior improvement in uremic parameters and inflammatory status. Gut-directed therapy represents a valuable adjunct in the medical management of CKD.