Effect of probiotic and synbiotic administration on the nutritional status of hemodialysis patients: a randomized-controlled trial.

PURPOSE: Malnutrition affects up to 54% of hemodialysis patients and is associated with increased mortality. We evaluated the effects of probiotic and synbiotic supplementation on nutritional status in maintenance hemodialysis patients.

METHODS

This single-blind randomized-controlled trial enrolled 60 hemodialysis patients randomly assigned to receive Lactobacillus plantarum (10 billion CFU twice daily), synbiotic (L. plantarum plus 3 g oat fiber β-glucans daily), or standard care for 24 weeks. Primary outcomes included triceps skinfold thickness, normalized protein catabolic rate (nPCR), and body mass index (BMI). Secondary outcomes included serum albumin, total protein, cholesterol, and leptin.

RESULTS

All 60 patients completed the trial. Triceps skinfold thickness increased significantly in the probiotic group (3.3 ± 2.2 mm) and synbiotic group (4.7 ± 2.2 mm) compared to placebo (0.0 ± 1.6 mm, p < 0.001). BMI increased more in treatment groups (probiotic: 1.4 ± 1.0 kg/m2; synbiotic: 1.7 ± 0.4 kg/m2) than in the placebo group (0.7 ± 0.9 kg/m2, p < 0.001). The probiotic group showed a significant within-group increase in albumin (0.25 ± 0.37 g/dL, p = 0.008), though between-group differences were not significant. No significant changes occurred in nPCR, total protein, cholesterol, or leptin. No serious adverse events were reported.

CONCLUSION

Probiotic and synbiotic supplementation safely and effectively improved anthropometric nutritional markers in hemodialysis patients, representing feasible adjunctive strategies for managing malnutrition.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06891105 (prospectively registered April 2025).