The effect of lactulose supplementation on fecal microflora of patients with chronic kidney disease; a randomized clinical trial

Tayebi-Khosroshahi, Hamid; Habibzadeh, Afshin; Niknafs, Bahram; Ghotaslou, Reza; Sefidan, Fatemeh Yeganeh; Ghojazadeh, Morteza; Moghaddaszadeh, Majid; Parkhide, Sahar

doi:10.15171/jrip.2016.34

Cited by 49 publications

(33 citation statements)

References 34 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This phenomenon can further contribute to the urea lowering effect observed in our HAM‐RS2 ESRD patient and in CKD animals, C‐ Earlier studies have demonstrated marked increase in secretion of creatinine (51) by colonic epithelium in CKD animals. Consumption of lactulose has been shown to further enhanced fecal excretion of nitrogenous waste products, favorably change microbiome and attenuate inflammation in patients with CKD . Therefore, enhanced viability of colonic epithelium with consumption of HAM‐RS2 can, in part, contribute to unloading of waste products and its lower serum concentration, and D‐ The slow transit rate of colonic contents marked by constipation which is a common feature of CKD can limit intestinal secretion of creatinine by lowering their concentration gradient and reducing the liquidity of the medium which is essential for secretion of solutes by epithelial cells.…”

Section: Discussionmentioning

confidence: 99%

Effect of high amylose resistant starch (HAM‐RS2) supplementation on biomarkers of inflammation and oxidative stress in hemodialysis patients: a randomized clinical trial

Khosroshahi

Vaziri

Abedi

et al. 2018

Hemodialysis International

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of high amylose resistant starch (HAM‐RS2) supplementation on biomarkers of inflammation and oxidative stress in hemodialysis patients: a randomized clinical trial

Khosroshahi

Vaziri

Abedi

et al. 2018

Hemodialysis International

Self Cite

View full text Add to dashboard Cite

show abstract

“…Since over 50 years, lactulose has been considered the “bifidus factor”, increasing fecal Bifidobacterium counts [ 68 ]. A number of subsequent studies have confirmed increased intestinal content of Bifidobacterium [ 69 – 75 ] and Lactobacillus [ 69 , 72 ] in human stool samples upon lactulose exposure. Those studies relied on conventional microbiological techniques and did not address the overall composition of the intestinal microbiota.…”

Section: Discussionmentioning

confidence: 99%

Microbiota stability in healthy individuals after single-dose lactulose challenge—A randomized controlled study

et al. 2018

View full text Add to dashboard Cite

Background and aimsLactulose is a common food ingredient and widely used as a treatment for constipation or hepatic encephalopathy and a substrate for hydrogen breath tests. Lactulose is fermented by the colon microbiota resulting in the production of hydrogen (H2). H2 is a substrate for enteropathogens including Salmonella Typhimurium (S. Typhimurium) and increased H2 production upon lactulose ingestion might favor the growth of H2-consuming enteropathogens. We aimed to analyze effects of single-dose lactulose ingestion on the growth of intrinsic Escherichia coli (E. coli), which can be efficiently quantified by plating and which share most metabolic requirements with S. Typhimurium.Methods32 healthy volunteers (18 females, 14 males) were recruited. Participants were randomized for single-dose ingestion of 50 g lactulose or 50 g sucrose (controls). After ingestion, H2 in expiratory air and symptoms were recorded. Stool samples were acquired at days -1, 1 and 14. We analyzed 16S microbiota composition and abundance and characteristics of E. coli isolates.ResultsLactulose ingestion resulted in diarrhea in 14/17 individuals. In 14/17 individuals, H2-levels in expiratory air increased by ≥20 ppm within 3 hours after lactulose challenge. H2-levels correlated with the number of defecations within 6 hours. E. coli was detectable in feces of all subjects (2 x 102–109 CFU/g). However, the number of E. coli colony forming units (CFU) on selective media did not differ between any time point before or after challenge with sucrose or lactulose. The microbiota composition also remained stable upon lactulose exposure.ConclusionIngestion of a single dose of 50 g lactulose does not significantly alter E. coli density in stool samples of healthy volunteers. 50 g lactulose therefore seems unlikely to sufficiently alter growth conditions in the intestine for a significant predisposition to infection with H2-consuming enteropathogens such as S. Typhimurium (www.clinicaltrials.gov NCT02397512).

show abstract

“…In addition, the potential safety concerns about the use of these agents (e.g., drug-induced nephrotoxicity and electrolyte disturbances) 5,128 may lead to possible undertreatment of constipation in patients with CKD, which could potentially contribute to their excess morbidity and mortality. In this context, the unique pharmacological properties of a few constipation agents, such as lactulose, a chloride channel activator (lubiprostone), and a guanylate cyclase C agonist (linaclotide), [19][20][21]129 may deserve special attention. In a study using an adenineinduced renal failure mouse model, Mishima et al 19 demonstrated that lubiprostone ameliorated the progression of CKD and the accumulation of uremic toxins by improving the gut microbiota and intestinal environment, suggesting its therapeutic potential for CKD.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Constipation in CKD

Sumida

Yamagata

Kövesdy

2020

Kidney International Reports

View full text Add to dashboard Cite

Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for constipation, some of which showing unique renoprotective properties, the adequate management of constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.

show abstract

The effect of lactulose supplementation on fecal microflora of patients with chronic kidney disease; a randomized clinical trial

Cited by 49 publications

References 34 publications

Effect of high amylose resistant starch (HAM‐RS2) supplementation on biomarkers of inflammation and oxidative stress in hemodialysis patients: a randomized clinical trial

Effect of high amylose resistant starch (HAM‐RS2) supplementation on biomarkers of inflammation and oxidative stress in hemodialysis patients: a randomized clinical trial

Microbiota stability in healthy individuals after single-dose lactulose challenge—A randomized controlled study

Constipation in CKD

Contact Info

Product

Resources

About