The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial

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This study was conducted to evaluate the effects of synbiotic supplementation on metabolic profiles in diabetic patients undergoing hemodialysis (HD). This randomized, double-blinded, placebo-controlled clinical trial was performed in 60 diabetic HD patients. Participants were randomly assigned into two groups to receive either synbiotic capsule, containing Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum (2 × 109 CFU/g each), plus 0.8 g/day of inulin (n = 30) or placebo (n = 30) for 12 weeks. Synbiotic supplementation significantly decreased fasting plasma glucose (β − 13.56 mg/dL; 95% CI, − 23.82, − 3.30; P = 0.01), insulin levels (β − 5.49 μIU/mL; 95% CI, − 6.92, − 4.05; P < 0.001), and insulin resistance (β − 2.25; 95% CI, − 3.02, − 1.48; P < 0.001), while increased the quantitative insulin sensitivity check index (β 0.02; 95% CI, 0.01, 0.02; P < 0.001) compared with the placebo. Additionally, synbiotic intake resulted in a significant reduction in high-sensitivity C-reactive protein (β − 2930.48 ng/mL; 95% CI, − 3741.15, − 2119.80; P < 0.001) and malondialdehyde levels (β − 0.60 μmol/L; 95% CI, − 0.99, − 0.20; P = 0.003). Moreover, we found a significant increase in total antioxidant capacity (β 142.99 mmol/L; 95% CI, 61.72, 224.25; P = 0.001) and total glutathione levels (β 131.11 μmol/L; 95% CI, 89.35, 172.87; P < 0.001) in the synbiotic group compared with the placebo group. Overall, synbiotic supplementation for 12 weeks had beneficial effects on glycemic control, biomarkers of inflammation, and oxidative stress in diabetic patients under HD. This study was registered in the Iranian website ( for registration of clinical trials ( IRCT2017090133941N17). IRCT2017090133941N17.

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Fig. 1



end-stage renal disease


fasting plasma glucose


glucagon-like peptide-1


total glutathione




homeostasis model of assessment-insulin resistance


high-density lipoprotein-cholesterol


high-sensitivity C-reactive protein


low-density lipoprotein-cholesterol




nitric oxide


quantitative insulin sensitivity check index


short-chain fatty acids


subjective global assessment


type 2 diabetes mellitus


total antioxidant capacity


very-low-density lipoprotein-cholesterol


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The present study was supported by a grant from the Vice-chancellor for Research, KAUMS, and Iran. The authors would like to thank the staff of Akhavan Clinic (Kashan, Iran) for their assistance in this project. The authors of this study would like to appreciate Dr. Naghmeh Mirhosseini for a scientific review and edition of the paper.


The research grant provided by Research Deputy of Kashan University of Medical Sciences (KAUMS).

Author information




ZA: Conception, design, and statistical analysis, drafting of the manuscript, and supervised the study.

AS, AM, MZ-M, FB, EA, VO, and MT-E: data collection and manuscript drafting.

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Correspondence to Zatollah Asemi.

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Soleimani, A., Motamedzadeh, A., Zarrati Mojarrad, M. et al. The Effects of Synbiotic Supplementation on Metabolic Status in Diabetic Patients Undergoing Hemodialysis: a Randomized, Double-Blinded, Placebo-Controlled Trial. Probiotics & Antimicro. Prot. 11, 1248–1256 (2019).

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  • Synbiotic supplementation
  • Diabetes
  • Hemodialysis
  • Metabolic status