EFFECTS OF LACTOBACILLUS CASEI VARIETY RHAMNOSUS (LCR35) ON SLEEP QUALITY AND ITCHING SEVERITY IN HEMODIALYSIS PATIENTS

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Abstract Title *

EFFECTS OF LACTOBACILLUS CASEI VARIETY RHAMNOSUS (LCR35) ON SLEEP QUALITY AND ITCHING SEVERITY IN HEMODIALYSIS PATIENTS

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Co-author 1

Kuo-Chin Hung corey926@gmail.com New Taipei City Hospital Nephrology New Taipei City Taiwan *

Co-author 2

Shih-Feng Chen gregchen93@gmail.com New Taipei City Hospital Nephrology New Taipei City Taiwan -

Co-author 3

Kuo-Cheng Lu kuochenglu@gmail.com Taipei Tzu Chi Hospital Nephrology New Taipei City Taiwan -

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Introduction

Hemodialysis patients frequently experienced poor sleep and itching, which substantially impaired their quality of life. Probiotic supplementation has been proposed as a potential adjunctive strategy to reduce uremic toxin–related symptoms. This study evaluated whether Lactobacillus casei variety rhamnosus (LCR35) could improve sleep quality and itching severity in hemodialysis patients.

Methods

A randomized, open-label, controlled trial was conducted with 78 participants (study group: n = 38; control group: n = 40). The intervention group received LCR35 probiotics (three sachets daily) for 12 weeks, while the control group received no probiotic supplementation (no placebo). Key outcomes included Pittsburgh Sleep Quality Index (PSQI) scores, itching severity (5D Itch Scale), and physiological markers such as uremic toxins [indoxyl sulfate (IS) and p-cresyl sulfate (PCS) levels]. Baseline and post-intervention data were analyzed for within-group changes using paired t-tests, and between-group differences were evaluated (including analysis of covariance to adjust for baseline values when appropriate). Correlation analyses were performed to examine relationships between changes in sleep quality and other outcomes.

Results

Baseline Demographic and Clinical Characteristics of the Study and Control Groups Uremic protein bound protein IS and PCS compare 2 groups. 5 D itching sore changes between 2 groups. PSQI independent sample t test compare 2 groups. The paired sample t-test on pre-and post- probiotics global PSQI score in the intervention group. Changes in Indoxyl Sulfate Levels Before and After Intervention in Both Groups. Participants in the LCR35 group exhibited improved sleep quality, as evidenced by a reduction in PSQI scores (13.16 ± 2.87 to 11.95 ± 3.34, p = 0.03), along with a decrease in itching severity (5D Itch Scale score: 13.50 ± 5.84 to 11.55 ± 4.69, p = 0.018) and lower indoxyl sulfate levels (231.97 ± 334.15 ng/ml to 113.61 ± 87.95 ng/ml, p = 0.014). In contrast, no significant changes were observed in the control group.

Conclusion

LCR35 supplementation was associated with improved sleep quality and reduced itching in HD patients, possibly by modulating gut microbiota and lowering uremic toxin levels, suggesting a potential role as an adjunctive therapy.

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