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Lactulose vs Lactobacillus acidophilus for patients with chronic kidney disease: A randomized controlled trial
Alshaimaa S Mubarak, Ashraf Elshazly, Abdelrahman Mokhtar, Nashwa M Azoz, Department of Internal Medicine-Nephrology Division, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71711, Egypt
Rabea A Gadelkareem, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA and Mokhtar A designed the research, collected the data, and wrote the paper; Azoz NM and Mubarak AS contributed to the statistical analysis; Azoz NM, Elshazly A, and Mubarak AS contributed to literature review, writing, and revision; Elshazly A contributed to the supervision of the work. All authors approved the paper.
AI contribution statement: Portions of this manuscript were edited using AI tools (Grammarly and QuillBot Online) for language refinement only. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Institutional review board statement: This study was approved by the Ethics Committee of the Faculty of Medicine, Assiut University, Egypt, on July 10, 2023.
Clinical trial registration statement: This study was registered on clinicaltrials.gov with the number NCT05934552.
Informed consent statement: All study participants provided informed written consent before participation in the study and enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Rabea A Gadelkareem, MD, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. rabeagad@aun.edu.eg
Received: March 10, 2026
Revised: May 31, 2026
Accepted: June 29, 2026
Published online: September 25, 2026
Processing time: 156 Days and 1.9 Hours
Revised: May 31, 2026
Accepted: June 29, 2026
Published online: September 25, 2026
Processing time: 156 Days and 1.9 Hours
Core Tip
Core Tip: Modulation of the gut-kidney axis represents a promising adjunctive strategy in the management of chronic kidney disease (CKD). This study highlights that both lactulose and Lactobacillus acidophilus improve uremic parameters and gastrointestinal symptoms in CKD patients; however, Lactobacillus acidophilus demonstrates a more pronounced effect on reducing uremic toxin burden and systemic inflammation. These findings support the clinical relevance of targeting gut dysbiosis to slow disease progression and improve patient outcomes in CKD.