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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Chronic kidney disease (CKD) is a major global health problem affecting over 800 million people, accounting for more than 10% of the world’s population. Mortality from CKD has increased by over 40% between 1990 and 2017, mainly due to cardiovascular complications. Accumulation of protein-bound uremic toxins (PBUTs), particularly p-cresyl sulfate and indoxyl sulfate, plays a key role in CKD progression and cardiovascular injury. These toxins originate from gut microbial metabolism of dietary protein, and their levels rise with constipation and gut dysbiosis. Lactulose, a disaccharide laxative with prebiotic properties, can modulate intestinal microbiota and reduce toxin generation. This study aims to compare the effects of Lactulose and Sennoside on serum PBUT levels in patients with stage 4 - 5 CKD.
Preliminary analysis of a single-center, open-label, randomized controlled trial conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Adults aged 18 - 70 years withCKD stage 4 - 5 and constipation (Bristol Stool Scale types 1 - 2 and <3 bowel movements/week for ≥3 months) were enrolled. Participants were randomly assigned (1:1) using a computerized sequence to receive either lactulose 30 mL once daily or sennoside 15 mg once daily for 12 weeks. Blood samples were collected at baseline and week 12 to measure serum p-cresyl sulfate and indoxyl sulfate using high-performance liquid chromatography (HPLC). A 24- hour urine urea nitrogen test was performed at weeks 6 to monitor dietary protein intake. The primary endpoint was the change in serum protein-bound uremic toxin levels in each groups. Secondary endpoints included changes in eGFR and nitrogen balance.
A total of 20 participants were analyzed from the planned 60 subjects in this interim dataset. Among them, 9 patients received lactulose and 11 received sennoside for 12 weeks. At week 12, the mean reduction in indoxyl sulfate was significantly greater in patients receiving lactulose compared with those receiving sennoside (-2.97 ± 5.96 mg/L vs +1.61 ± 6.43 mg/L; p = 0.04). There was no statistically significant difference in p-cresyl sulfate between the two groups (-1.24 ± 2.47 mg/L in the lactulose group vs -0.36 ± 1.31 mg/L in the sennoside group; p = 0.07). Serum indoxyl sulfate significantly decreased from baseline in the lactulose group (p = 0.04), whereas no statistically significant change was observed in p-cresyl sulfate. Both indoxyl sulfate and p- cresyl sulfate levels showed no significant changes in the sennoside group.
In this preliminary analysis, patients receiving lactulose demonstrated a greater reduction in indoxyl sulfate levels after 12 weeks compared with those receiving sennoside. Although p-cresyl sulfate showed a trend toward greater reduction with lactulose, the finding was limited by the small sample size. These results suggest a potential uremic toxin–lowering effect of lactulose in pre-dialysis CKD patients. Further analysis with the complete study population is warranted to confirm these findings and assess their clinical relevance.
