The Effect of Probiotic Use on Gut Leakage Measured by Zonulin and its Relation to P Cresyl Sulfate and Inflammation in Hemodialysis Patients: A prospective controlled clinical study.

Objective: In chronic kidney disease, gut dysbiosis increases intestinal permeability, allowing toxins to enter the bloodstream and causing inflammation. This study aimed to assess the impact of probiotic supplementation on serum Zonulin levels, P-cresyl sulfate and highly sensitive C-reactive protein (hs-CRP) in hemodialysis patients. Materials and Methods: Forty hemodialysis patients were enrolled and divided into either a probiotic group or a control group (20 patients per group). The probiotic group received supplements for 3 months. Serum Zonulin, hs-CRP and P-cresyl sulfate were measured at baseline and after the 3-month intervention. Results: After 3 months of probiotic administration, the probiotic group showed a statistically significant decrease in serum Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001) and hs-CRP (p = 0.037). Furthermore, a significant difference was observed between the two groups regarding post-intervention levels of Zonulin (p < 0.001), P-cresyl sulfate (p < 0.001), and hs-CRP (p < 0.001). Conclusions: Probiotic administration in hemodialysis patients improved intestinal barrier integrity, reduced gut-derived toxin levels, and lowered systemic inflammation.