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

Introduction: Lactulose is a prebiotic with bifidogenic and urea reduction effects. It can improve Bifidobacteria and Lactobacilli counts in healthy humans and it may possibly have similar effects in chronic kidney disease (CKD) patients. Objectives: To investigate the effect of lactulose on fecal microflora of patients with CKD. Patients and Methods: Thirty-two patients with stages 3 and 4 of CKD (43.8% male with mean age of 58.09 ± 12.75 years) were randomly assigned to intervention (n = 16) and control (n = 16) groups. Patients in intervention group received 30 mm lactulose syrup three times a day for an 8-week period. Control group received placebo 30 mm three times a day. A fecal sample was obtained from all patients at the beginning and at the end of the study and Bifidobacteria and Lactobacilli was counted. Results: Creatinine (Cr) significantly decreased in intervention group (3.90 ± 1.43 to 3.60 ± 1.44, P = 0.003) and increased in control group (3.87 ± 2.08 to 4.11±1.99, P = 0.03). Although Bifidobacterial and Lactobacilli counts were similar before intervention, they were significantly higher at the end of the study in lactulose group (P = 0.01 and P = 0.04, respectively). Lactulose led to significant increase in fecal Bifidobacterial counts (3.61 ± 0.54 to 4.90 ± 0.96, P < 0.001) and Lactobacilli counts (2.79 ± 1.00 to 3.87 ± 1.13, P < 0.001), while the change in placebo group was not significant. Conclusion: Lactulose administration will increase Bifidobacteria and Lactobacillus counts in patients with CKD.