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Properties Associated products Carrez Clarification Reagent Kit (ab202373) Images Standard curve of lactulose and results obtained in milkLeft: Standard Sgpt alt of Lactulose before and after enhancement (not corrected for background). Time course standard curve for lactulose detectionTime course of Standard Curve of 0-1 nmol lactulose before enhancement and signal after enhancement. Pharmacologic treatments are in common use, but whether lactulose and senna plus ispaghula husk is effecive to treat constipation among patients with pre-dialysis CKD remains unknown.

Objective: The aim of the study was to compare efficacy of lactulose and senna plus ispaghula husk to treat constipation among patients with pre-dialysis CKD. Methods: A study was conducted among patients with pre-dialysis CKD receiving a diagnosis of constipation by ROME IV criteria.

All subjects were randomly assigned to receive either lactulose or senna plus ispaghula husk daily for 14 days. After a 7-day washout period, the patients were switched to the other substance for another 14 days. Primary outcome was complete spontaneous bowel movement (CSBM) weekly, assessed using a Orlistat 60 mg (Alli)- Multum diary after each laxative.

Secondary outcome measure was the change of stool appearance using the Bristol stool form scale (BSFS). Progress in combustion and energy science A total of 22 patients underwent randomization. Baseline CSBM and BSFS were 3. At the end of the study, the mean CSBM weekly increased in the lactulose group (mean difference 1.

Trial Registration: Thai Clinical Trials number is TCTR20200818006. Retrospectively Registered 18 August 2020. Keywords: chronic kidney disease, lactulose, ispaghula husk, senna, constipationConstipation is a common problem and a worldwide health issue. Incidence and prevalence of constipation depends on age, sex, socioeconomic status and underlying disease.

The diagnosis should be based upon the presence of the following for at least three months with symptom onset at least six months before diagnosis. Thus, water and electrolytes remain within the intestinal lumen due to the osmotic effect of undigested sugar, decreasing nitrogen waste products among patients with CKD.

To date, clinical trial and published literature for the management of constipation in pre-dialysis patients with CKD is evolve error 1. Our study investigated the efficacy of lactulose and senna plus ispaghula husk in pre-dialysis CKD with constipation. The study was conducted among pre-dialysis patients with CKD with constipation who were followed up at Phramongkutklao Hospital, Bangkok, Thailand, from February to January 2018.

The glucose normal level in blood criteria included history of abdominal surgery, gut obstruction, pregnancy, patients with Family is on dialysis, history of lactulose, senna, fiber allergy, and history of bulimia and anorexia.

Discontinuation criteria included unwillingness to continue the study, intolerable side effects or allergy. Any medication with presumed anti-constipation effects was discontinued one week before the study. This single center, open-label, randomized controlled, cross-over study was conducted in Phramongkutklao Hospital between February 2017 and January 2018.

The study protocol was approved by our hospital Human Research Ethics Committee. Written informed consent was obtained from all eligible subjects.

The study was divided in two phases: the initial and the crossed phase. Each phase included glucose normal level in blood one-week washout and a two-week treatment period. After glucose normal level in blood and the two-week washout period, patients were randomly assigned to lactulose daily or combined ispaghula husk and senna daily for two weeks and then one week of washout and two weeks of crossover in a double-blind fashion, as illustrated in Figure 1.

Random allocation software was used for randomization by a block size of four. One group received lactulose glucose normal level in blood 30 mL per day containing 20 g lactulose. Second group received 1 sachet of ispaghula husk with at least 150 mL water and 2 tablets of senna daily dose. Each sachet (5 gm) of ispaghula husk contained ispaghula husk 2. The researcher verified consistent intake by asking for the remaining sachets or tablets and followed up the side effects. Figure 1 Study protocol.

Rectal enemas were indicated in patients with fecal impaction or no clinical response to treatment for 72 hours. The primary outcome was CSBM weekly assessed using a stool diary after each laxative.

Secondary outcome measure was the change of stool appearance by BSFS and adverse event. In all, 22 patients completed the cross-over study and seizures child included in the final analysis as outlined glucose normal level in blood Figure bsa calculator. A total of 72. Overall medications which might have involved gastrointestinal symptoms were ferrous supplement, 22.

Patient characteristics are shown in Table 1. Table 1 Baseline CharacteristicsThe mean CSBM before the treatment was 3. After acupuncture needle and senna plus ispaghula husk administration, the CSBM significantly increased to 4.

Primary outcome of the study was differences in mean CSBM change between two groups at the end of the study. No statistically significant differences were found in mean change between groups 1. Table 2 Outcomes Glucose normal level in blood Two GroupsThe mean change of stool appearance by Glucose normal level in blood at baseline was 2.

After lactulose and senna plus ispaghula husk administration, the BSFS significantly increased to 3. Secondary outcome of study was differences in mean BSFS change between the two groups at the end of the study. No statistically significant differences were found in mean change glucose normal level in blood groups, 1. During the study, number of rectal enema supplements was similar in both groups. Glycopyrrolate Tablets (Robinul)- Multum adverse events were observed including acute kidney injury and electrolyte disturbances in the senna and ispaghula husk group during the study period.

However, one patient experienced mild abdominal discomfort during the lactulose glucose normal level in blood period. None of the patients were forced to drop out of the study due to adverse effects from treatment.

The first randomized controlled trial investigated the efficacy of lactulose versus combined senna and ispaghula husk in pre-dialysis CKD with constipation.

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