الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Intestinal dysbiosis has been demonstrated in chronic kidney disease (CKD) patients and has been considered as a contributor to disease progression due to over-production of microbial uremic toxins. Gum acacia (GA) has been proven to possess prebiotic effect. Several preclinical and clinical studies have investigated GA as a potential herbal remedy for CKD management. To the best of our knowledge, this is the first clinical study to investigate the possible mechanism mediated by GA in retarding CKD progression and examine the effect of GA addition in CKD diet on both gut-microbiota derived indoxyl sulfate (IS) and para cresyl sulfate (PCS).A parallel two-arms with 1:1 allocation, open-labelled randomized clinical trial was conducted in the period between July 2022 till April 2023. A total of 108 patients were eligible for inclusion and were randomly allocated into intervention (25 grams gum acacia daily) arm and control arm.A total of 80 patients completed the study. At baseline, both groups did not significantly differ in age or any other socio-demographic variables. After 12 weeks of follow up, intervention group showed a significant decrease in serum levels of both PCS and IS by 13.08% (p=0.0008) and 20.3% (p= 0.001) respectively, while both levels of PCS and IS increased significantly in control group by 24.1 % (P 0.007) and 11.28% (P 0.01) respectively. Additionally, a significant rise in eGFR was demonstrated in the intervention by 13.15%(p<0.001), while it was significantly declined in the control group by 9.09% (p<0.001). Moreover, hemoglobin level(g/dl) was noticeably increased in the intervention group by 2.91% (p= 0.023), while a significant DROP in the hemoglobin level of 0.7% was observed in the control group (p= 0.023). No significant difference was observed in the levels of electrolytes in both groups.