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

doi:10.5527/wjn.120870

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Nephrol. Sep 25, 2026; 15(3): 120870
Published online Sep 25, 2026. doi: 10.5527/wjn.120870

Table 1 Baseline data of the studied groups, n (%)/mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Age (years)	46.34 ± 7.11	52.11 ± 3.67	50.11 ± 4.55	0.09	0.30	0.12	0.31
Sex				0.70	0.69	0.76	0.43
Male	30 (60)	35 (70)	32 (64)
Female	20 (40)	15 (30)	18 (36)
BMI (kg/m²)	25.55 ± 2.35	24.57 ± 4.01	25.08 ± 3.18	0.45	0.30	0.06	0.21
Current smoking	10 (20)	11 (22)	14 (28)	0.90	0.87	0.28	0.45
DM	20 (40)	21 (42)	23 (46)	0.32	0.06	0.11	0.66
HTN	18 (36)	17 (34)	20 (40)	0.06	0.55	0.05	0.50
COPD	5 (10)	5 (10)	6 (12)	0.21	0.65	0.55	0.45
Dyslipidemia	3 (6)	2 (4)	4 (8)	0.55	0.45	0.21	0.19
Stages of CKD				0.64	0.76	0.21	0.10
Stage-III	19 (38)	20 (40)	17 (34)
Stage-IV	16 (32)	18 (36)	17 (34)
Stage-Va	15 (30)	12 (24)	16 (32)

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

LA: Lactobacillus acidophilus; BMI: Body mass index; DM: Diabetes mellitus; HTN: Hypertension; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease.

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Table 2 Uremic manifestations among the studied groups during different times, n (%)/mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
At baseline
Dyspnea	1 (2)	0	2 (4)	0.45	0.96	0.11	0.55
Vomiting	1 (2)	2 (4)	1 (2)	0.33	0.11	0.06	0.30
Lower limb edema	0	1 (2)	1 (2)	0.87	0.96	0.96	0.06
SBP (mmHg)	134.56 ± 23.45	136.55 ± 32.11	139.19 ± 44.44	0.09	0.22	0.10	0.34
DBP (mmHg)	89.09 ± 8.54	90.11 ± 8.88	88.34 ± 10.22	0.54	0.76	0.56	0.10
UOP (mL/24 hours)	2330.11 ± 795.56	2311.67 ± 897.65	2404.44 ± 453.22	0.07	0.46	0.08	0.77
End of 1^st month
Dyspnea	1 (2)	0	1 (2)	0.45	0.96	0.10	0.96
Vomiting	1 (2)	0	0	0.33	0.96	0.96	-
Lower limb edema	0	1 (2)	1 (2)	0.45	0.96	0.96	0.10
SBP (mmHg)	131.09 ± 22.19	132.60 ± 19.56	132.56 ± 23.10	0.76	0.39	0.21	0.08
DBP (mmHg)	85.67 ± 8.56	88.56 ± 8.19	88.90 ± 10.87	0.40	0.34	0.10	0.19
UOP (mL/24 hours)	2345.01 ± 675.56	2401.10 ± 453.67	2398.01 ± 542.22	0.56	009	0.21	0.45
End of 2^nd month
Dyspnea	1 (2)	0	0	0.33	0.96	0.96	-
Vomiting	0	0	1 (2)	0.33	-	0.96	0.96
Lower limb edema	0	1 (2)	0	0.33	0.96	-	0.96
SBP (mmHg)	131.23 ± 13.56	130.79 ± 19.21	132.89 ± 18.50	0.76	0.39	0.21	0.08
DBP (mmHg)	87 ± 9.59	87.56 ± 7.89	86.54 ± 11.34	0.40	0.34	0.10	0.19
UOP (mL/24 hours)	2456.78 ± 609	2490.67 ± 444	2500.1 ± 600.11	0.56	009	0.21	0.45
End of 3^rd month
Dyspnea	1 (2)	0	1 (2)	0.43	0.96	0.06	0.96
Vomiting	1 (2)	1 (2)	0	0.43	0.06	0.96	0.96
Lower limb edema	1 (2)	0	1 (2)	0.43	0.96	0.06	0.96
SBP (mmHg)	132.11 ± 23.34	133.99 ± 22.17	138.10 ± 22.19	0.33	0.62	0.56	0.22
DBP (mmHg)	88.87 ± 20.22	89.65 ± 7.65	90.44 ± 9.56	0.40	0.66	0.06	0.10
UOP (mL/24 hours)	2356.76 ± 654.33	2401.11 ± 456.65	2404.44 ± 675.55	0.31	0.40	0.87	0.76

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

LA: Lactobacillus acidophilus; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; UOP: Urine output.

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Table 3 Baseline laboratory data of the studied groups, mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Hemoglobin (mg/dL)	10.52 ± 2.11	10.93 ± 1.87	10.56 ± 1.94	0.22	0.09	0.17	0.18
Platelets (10³/μL)	282.17 ± 55.67	271.25 ± 69.56	289.20 ± 43.41	0.64	0.76	0.06	0.22
Leucocytes (10³/μL)	5.55 ± 2.56	5.90 ± 2.33	5.09 ± 2.19	0.90	0.56	0.10	0.78
Bilirubin (mg/dL)	1.01 ± 0.50	0.99 ± 0.11	1.11 ± 0.21	0.12	0.09	0.34	0.19
Albumin (g/dL)	3.33 ± 1.21	3.21 ± 0.69	3.30 ± 0.87	0.38	0.73	0.69	0.28
AST (U/L)	31.09 ± 2.87	30.09 ± 4.56	30.66 ± 6.70	0.68	0.31	0.54	0.11
ALT (U/L)	29.45 ± 3.19	28.44 ± 4.59	24.56 ± 8.33	0.09	0.57	0.50	0.75
Urea (mg/dL)	56.34 ± 5.60	53.04 ± 9.97	55.67 ± 8.56	0.43	0.51	0.37	0.49
Creatinine (mg/dL)	3.90 ± 1.11	4.05 ± 1.22	3.88 ± 1.99	0.18	0.18	0.19	0.35
ACR	123.05 ± 25.17	113.16 ± 33.93	115.07 ± 25.67	0.58	0.78	0.43	0.18
eGFR (mL/minute/1.73 m²)	46.57 ± 9.89	48.17 ± 8.64	50.45 ± 7.11	0.77	0.67	0.08	0.50
Sodium (mmol/L)	133.15 ± 0.05	132.01 ± 0.26	133.03 ± 0.84	0.10	0.78	0.45	0.22
Potassium (mmol/L)	4.91 ± 1.33	4.82 ± 0.87	4.06 ± 1.87	0.09	0.10	0.08	0.11
Calcium (mg/dL)	9.06 ± 1.89	9.17 ± 2.31	8.93 ± 1.23	0.72	0.22	0.21	0.67
Magnesium (mmol/L)	1.79 ± 0.15	1.71 ± 0.99	1.81 ± 0.49	0.33	0.44	0.32	0.08
Phosphorus (mmol/L)	4.50 ± 0.81	4.93 ± 1.83	4.65 ± 1.45	0.21	0.09	0.45	0.33
RBS (mg/dL)	208.08 ± 8511	211.17 ± 55.43	221.03 ± 27.45	0.22	0.21	0.56	0.56
HbA1C (%)	7.19 ± 1.22	7.43 ± 0.70	8.01 ± 0.44	0.54	0.45	0.44	0.41
Cholesterol (mg/dL)	203.09 ± 24.56	205.15 ± 45.10	219.79 ± 45.67	0.09	0.67	0.09	0.21
Triglycerides (mg/dL)	133.94 ± 28.29	129.33 ± 33.10	135.90 ± 18.11	0.20	0.11	0.67	0.98
LDL (mg/dL)	119.01 ± 24.21	122.09 ± 50.43	109.81 ± 34.54	0.19	0.76	0.15	0.51
HDL (mg/dL)	48.11 ± 7.66	50.45 ± 7.22	49.41 ± 5.89	0.32	0.07	0.23	0.07

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

LA: Lactobacillus acidophilus; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ACR: Albumin/creatinine ratio; eGFR: Estimated glomerular filtration rate; RBS: Random blood sugar; HbA1C: Glycated hemoglobin A1c; LDL: Low density lipoprotein; HDL: High density lipoproteins.

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Table 4 Follow-up laboratory data of the studied group after one month, mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Hemoglobin (mg/dL)	10.90 ± 2.45	10.60 ± 2.34	10.83 ± 1.76	0.67	0.32	0.33	0.13
Platelets (10³/μL)	291.89 ± 55.11	281.90 ± 45.67	289.11 ± 54.10	0.44	0.36	00.9	0.18
Leucocytes (10³/μL)	6.46 ± 2.78	7.18 ± 2.98	6.66 ± 2.17	0.45	0.22	0.12	0.34
Bilirubin (mg/dL)	0.90 ± 0.21	1.01 ± 0.12	0.95 ± 0.04	0.99	0.92	0.72	0.10
Albumin (g/dL)	3.39 ± 1.22	3.38 ± 0.43	3.39 ± 0.95	0.54	0.45	0.88	0.57
AST (U/L)	23.89 ± 3.90	30.24 ± 4.36	30.57 ± 6.89	0.63	0.25	0.87	0.65
ALT (U/L)	30.19 ± 3.11	28.68 ± 4.77	24.46 ± 8.17	0.14	0.63	0.49	0.81
Urea (mg/dL)	56.12 ± 5.64	52.9 ± 9.97	55.65 ± 8.36	0.87	0.16	0.18	0.57
Creatinine (mg/dL)	3.67 ± 0.81	4.02 ± 1.03	3.85 ± 1.82	0.54	0.07	0.68	0.56
ACR	120.91 ± 25.24	110.46 ± 33.71	109.31 ± 25.93	0.06	0.19	0.68	0.09
eGFR (mL/minute/1.73 m²)	47.56 ± 9.59	49.61 ± 8.74	50.32 ± 7.98	0.08	0.83	0.78	0.87
Sodium (mmol/L)	133.27 ± 0.11	132.34 ± 0.47	132.75 ± 0.58	0.88	0.12	0.74	0.42
Potassium (mmol/L)	4.56 ± 1.18	4.36 ± 1.07	4.56 ± 1.61	0.61	0.09	0.96	0.55
Calcium (mg/dL)	8.97 ± 2.11	8.68 ± 2.13	9.29 ± 0.94	0.74	0.45	0.38	0.55
Magnesium (mmol/L)	2.17 ± -0.12	1.82 ± 1.03	2.22 ± 0.66	0.21	0.96	0.86	0.91
Phosphorus (mmol/L)	4.74 ± 0.61	5.11 ± 1.61	4.21 ± 1.74	0.38	0.29	0.72	0.59
RBS (mg/dL)	214.45 ± 50.71	211.1 ± 55.52	220.75 ± 27.47	0.14	0.95	0.81	0.95
HbA1C (%)	6.76 ± 1.25	7.04 ± 0.56	7.56 ± 0.26	0.78	0.99	0.56	0.71
Cholesterol (mg/dL)	203.47 ± 24.66	205.08 ± 44.98	219.74 ± 45.84	0.79	0.39	0.75	0.21
Triglycerides (mg/dL)	133.11 ± 28.42	128.88 ± 33.32	135.66 ± 18.06	0.96	0.14	0.63	0.12
LDL (mg/dL)	108.62 ± 24.34	122.45 ± 50.29	109.65 ± 34.81	0.88	0.45	0.07	0.58
HDL (mg/dL)	46.78 ± 7.60	50.37 ± 7.18	49.77 ± 5.6	0.97	0.09	0.28	0.32

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

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Table 5 Follow-up laboratory data of the studied group after two months, mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Hemoglobin (mg/dL)	10.87 ± 2.11	10.90 ± 2.01	10.73 ± 2.45	0.55	0.92	0.30	0.12
Platelets (10³/μL)	301 ± 66.56	312.40 ± 55.67	299.02 ± 60.55	0.40	0.46	0.19	0.10
Leucocytes (10³/μL)	7.11 ± 1.78	7.90 ± 3.09	7.09 ± 2.01	0.38	0.78	0.80	0.34
Bilirubin (mg/dL)	1.01 ± 0.21	0.98 ± 0.10	0.95 ± 0.01	0.91	0.91	0.70	0.19
Albumin (g/dL)	3.38 ± 0.45	3.36 ± 0.40	3.34 ± 0.99	0.50	0.65	0.88	0.50
AST (U/L)	33.19 ± 4.90	36.24 ± 1.09	31.57 ± 5.60	0.60	0.45	0.11	0.65
ALT (U/L)	35.67 ± 5.90	33.11 ± 5.60	39.11 ± 8.01	0.10	0.22	0.50	0.89
Urea (mg/dL)	52.98 ± 1.64	53.45 ± 4.98	55.60 ± 4.36	0.80	0.22	0.19	0.67
Creatinine (mg/dL)	3.57 ± 1.22	4 ± 1.13	3.88 ± 1.65	0.50	0.10	0.21	0.78
ACR	119.91 ± 14.56	115.06 ± 23.67	112.31 ± 19.45	0.22	0.12	0.45	0.22
eGFR (mL/minute/1.73 m²)	49.56 ± 2.59	49.89 ± 3.56	50.11 ± 7.01	0.08	0.93	0.45	0.11
Sodium (mmol/L)	133.27 ± 0.10	133.14 ± 0.37	132.45 ± 0.08	0.45	0.16	0.98	0.54
Potassium (mmol/L)	4.01 ± 1.23	4.06 ± 1.07	3.98 ± 1.01	0.21	0.09	0.10	0.42
Calcium (mg/dL)	8.90 ± 1.67	8.67 ± 2.01	9.19 ± 0.56	0.56	0.31	0.98	0.12
Magnesium (mmol/L)	2.07 ± 0.10	1.98 ± 0.45	2.21 ± 0.60	0.21	0.56	0.88	0.91
Phosphorus (mmol/L)	4.76 ± 0.61	5.09 ± 1.22	4.20 ± 0.56	0.40	0.23	0.11	0.59
RBS (mg/dL)	210.11 ± 4.35	209.1 ± 55.52	219.45 ± 27.90	0.10	0.19	0.40	0.86
HbA1C (%)	6.90 ± 1.25	7.14 ± 0.48	7.22 ± 0.19	0.08	0.20	0.18	0.50
Cholesterol (mg/dL)	231.56 ± 24.11	234.18 ± 44.99	230.11 ± 23.19	0.09	0.29	0.40	0.21
Triglycerides (mg/dL)	134.56 ± 28.67	132.88 ± 17.90	130.65 ± 22.19	0.44	0.13	0.63	0.87
LDL (mg/dL)	145.67 ± 24.11	140.56 ± 34.60	130.05 ± 33.01	0.08	0.17	0.20	0.18
HDL (mg/dL)	49.11 ± 7.01	50.47 ± 5.60	48.56 ± 6.90	0.07	0.08	0.30	0.19

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

Full Size Table

Table 6 Follow-up laboratory data of the studied group after three months, mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Hemoglobin (mg/dL)	10.86 ± 2.15	10.93 ± 2.02	10.98 ± 2.0	0.58	0.88	0.29	0.4
Platelets (10³/μL)	281.68 ± 55.52	270.89 ± 69.83	288.91 ± 43.52	0.43	0.65	0.22	0.33
Leucocytes (10³/μL)	5.93 ± 2.71	6.04 ± 2.33	5.36 ± 1.89	0.41	0.63	0.21	0.32
Bilirubin (mg/dL)	0.69 ± 0.31	1.36 ± 0.07	1.6 ± 0.11	0.43	0.65	0.22	0.33
Albumin (g/dL)	3.6 ± 1.1	3.7 ± 0.72	3.11 ± 0.97	0.53	0.75	0.27	0.38
AST (U/L)	30.95 ± 3.02	29.73 ± 4.82	30.36 ± 6.47	0.63	0.85	0.32	0.43
ALT (U/L)	29.37 ± 3.1	28.85 ± 4.58	24.88 ± 8.3	0.13	0.35	0.07	0.18
Urea (mg/dL)	50.11 ± 4.43	47.04 ± 5.57	54.07 ± 10.22	0.44	0.66	0.22	0.33
Creatinine (mg/dL)	3.28 ± 1.98	3.22 ± 1.45	3.65 ± 1.56	0.53	0.75	0.27	0.38
ACR	120.57 ± 13.45	109.33 ± 21.45	114.33 ± 22.22	0.25	0.47	0.13	0.24
eGFR (mL/minute/1.73 m²)	50.55 ± 7.77	54.66 ± 5.66	53.44 ± 3.17	0.11	0.33	0.06	0.17
Sodium (mmol/L)	133.37 ± 0.21	132.27 ± 0.42	132.81 ± 0.69	0.48	0.7	0.24	0.35
Potassium (mmol/L)	4.88 ± 1.09	5.25 ± 0.78	4.14 ± 1.59	0.24	0.46	0.12	0.23
Calcium (mg/dL)	9.55 ± 2.11	9.23 ± 2.08	9.35 ± 1.38	0.59	0.81	0.3	0.41
Magnesium (mmol/L)	1.68 ± 0.45	2.05 ± 1.23	2.03 ± 0.41	0.24	0.46	0.12	0.23
Phosphorus (mmol/L)	4.19 ± 0.83	5.38 ± 1.68	4.83 ± 1.65	0.43	0.65	0.22	0.33
RBS (mg/dL)	208.11 ± 58.12	211.13 ± 55.3	220.95 ± 27.45	0.13	0.35	0.07	0.18
HbA1C (%)	7.21 ± 1.03	7.55 ± 0.92	7.76 ± 0.35	0.11	0.33	0.06	0.17
Cholesterol (mg/dL)	202.83 ± 24.56	205.26 ± 44.84	220.04 ± 45.97	0.12	0.34	0.06	0.17
Triglycerides (mg/dL)	133.74 ± 28.31	129.43 ± 33.03	135.54 ± 18.23	0.47	0.69	0.24	0.35
LDL (mg/dL)	119.18 ± 24.18	122.25 ± 50.27	109.7 ± 34.54	0.11	0.33	0.06	0.17
HDL (mg/dL)	48.07 ± 7.91	50.19 ± 7.4	49.64 ± 5.87	0.1	0.32	0.05	0.16

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

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Table 7 Delta changes in renal functions after three months compared to baseline data, mean ± SD

	Lactulose group (n = 50)	LA group (n = 50)	Control group (n = 50)	P value	¹P value	²P value	³P value
Delta urea	-5 ± 2.45	-12.45 ± 3.01	-1.79 ± 3.01	0.03	0.04	0.33	0.02
Delta creatinine	-7.33 ± 2.88	-20.01 ± 3.45	-6.55 ± 2.44	< 0.001	0.03	0.11	0.01
Delata ACR	2.40 ± 0.86	3.50 ± 0.67	1.09 ± 0.55	0.57	0.45	0.09	0.21
Delta eGFR	8.66 ± 2.09	9.55 ± 2.22	6.67 ± 1.11	0.33	0.34	0.65	0.09

¹P: Lactulose group vs Lactobacillus acidophilus group.

²P: Lactulose group vs control group.

³P: Lactobacillus acidophilus group vs control group.

LA: Lactobacillus acidophilus; ACR: Albumin/creatinine ratio; eGFR: Estimated glomerular filtration rate.

Full Size Table

Citation: Mubarak AS, Elshazly A, Mokhtar A, Gadelkareem RA, Azoz NM. Lactulose vs Lactobacillus acidophilus for patients with chronic kidney disease: A randomized controlled trial. World J Nephrol 2026; 15(3): 120870
URL: https://www.wjgnet.com/2220-6124/full/v15/i3/120870.htm
DOI: https://dx.doi.org/10.5527/wjn.120870

Mubarak AS, Elshazly A, Mokhtar A, Gadelkareem RA, Azoz NM. Lactulose vs Lactobacillus acidophilus for patients with chronic kidney disease: A randomized controlled trial. World J Nephrol 2026; 15(3): 120870 [DOI: 10.5527/wjn.120870]

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