BIOMODULATION OF THE TOXIC AND NUTRITIONAL EFFECTS OF SMALL-BOWEL BACTERIAL OVERGROWTH IN END-STAGE KIDNEY-DISEASE USING FREEZE-DRIED LACTOBACILLUS-ACIDOPHILUS

Small bowel bacterial overgrowth (SBBO), well known to occur in end-st age kidney failure, is responsible for producing uremic toxins and con tributing to the patient's decreased nutritional well-being. In this s tudy, 8 hemodialysis patients were treated with a course of oral Lacto bacillus acidophilus (LBA) in an attempt to alter this SBBO. LBA treat ment was effective in lowering 2 compounds generated in vivo, Serum di methylamine (DMA) levels dropped from 224 +/- 47 to 154 +/- 47 pg/dl a t the end of LBA treatment (p < 0.001), Nitrosodimethylamine, a carcin ogen, levels also decreased significantly from 178 +/- 67 (untreated) to 83 +/- 49 ng/kg (after LBA treatment). Patients nutritional status, assessed as serum albumin, body weight, caloric intake, midarm muscle area (MAMA) and appetite improved modestly, but not significantly, LB A changed small bowel pathobiology by modifying metabolic actions of S BBO, reducing in vivo generation of toxins and carcinogens and promoti ng nutrition with no adverse side effects.