Probiotic supplementation in diabetic hemodialysis patients has beneficial metabolic effects.

Prospective randomized, double-blind, placebo-controlled, parallel-group trial in 60 adults with diabetes mellitus undergoing hemodialysis (aged 18–80 years; 30 per group; 66.7% male; Type 1 DM 10%, Type 2 DM 90%; all on insulin therapy; matched on sex, dialysis duration, BMI, and age before randomization).

Oral probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum; 2×10^9 CFU of each strain per capsule (total 6×10^9 CFU); taken once daily for 12 weeks.

After 12 weeks, probiotic supplementation significantly improved glycemic control versus placebo: fasting plasma glucose fell by about 22 mg/dL (vs rise of 6.6 mg/dL; P=0.01); insulin decreased by 6.4 mIU/mL (vs rise of 2.3; P<0.001); HOMA-IR decreased by 2.9 (vs rise of 1.0; P<0.001); QUICKI increased by 0.03 (vs decline of 0.02; P<0.001); HbA1c decreased by 0.4% (vs 0.1%; P=0.01). Inflammation and oxidative stress biomarkers also improved: hs-CRP reduced by ~1933 ng/mL, MDA decreased by ~0.3 μmol/L, TAC increased by ~15.3 mmol/L (all P<0.05); SGA score improved (P=0.01). Lipid profiles did not change significantly. No adverse events; adherence was high. Some effects (HOMA-B and TAC) were not robust to adjustment for baseline values, age, and BMI; overall findings suggest probiotic supplementation may support glycemic control and reduce inflammation/oxidative stress in diabetic HD patients, though long-term clinical outcomes were not assessed.

Small, single-center study (n=60) with a 12-week duration; surrogate endpoints assessed; gut microbiota not characterized; relatively low CFU dosage; majority in the Type 2 diabetes subgroup and all on insulin; some outcomes attenuated after adjustment for baseline variables; 5 participants withdrew; results may not generalize to all HD patients.