**3. Results and discussion**

At the beginning of this study, a comprehensive examination of patients on programmed HD was carried out, including the determination of clinical and laboratory parameters, an assessment of the quality of life by a questionnaire method and a bacteriological analysis of the colon microbiocenosis.

When analyzing laboratory data before using the synbiotic, comparable indicators were found in both groups: a moderate increase in ESR (43.7 ± 21.4 and 42.4 ± 18.9 mm/h) and CRP (6.8 ± 3.1 and 6.5 ± 2.9 g/L), normal leukocyte count (6.7–6.8\*109 /L), increased levels of blood urea (19.6–19.4 mmol/L) and blood creatinine (697.1–688.5 μmol/L), indicating the presence of chronic moderate inflammation and azotemia in patients receiving PG. The Kt/V index for urea was 1.43 ± 0.16 and 1.41 ± 0.18, which indicated the adequacy of the dialysis dose (**Table 1**).

ESR, erythrocyte sedimentation rate; C-RP, C-reactive protein; Le, leukocyte count; Kt/V for urea index, the dialysis adequacy index (for urea).

An in-depth study of the microbiota in patients with CKD undergoing hemodialysis showed that among representatives of the phylum Actinobacteria in the microbiocenosis of the colon, representatives of the genus *Bifidobacterium* are found in 75% of the examined, in 43.7% of them the detected number of bifidobacteria is significantly lower than normal. 1–2 species of bifidobacteria were isolated from each patient, and *Bifidobacterium longum* prevailed in the species structure −43.75% (**Figures 1**–**4**).

Using our technique, in this study, such rarely identified species of the Enterobacteriaceae family as *Enterobacter asburiae*, *Enterobacter kobei*, *Citrobacter youngae*, *Serratia liquefaciens*, and *Raoultella planticola* were isolated.

Dysbiotic changes in colon microbiocenosis of varying degrees were detected in 100% of the examined patients (**Figure 5**).

During the analysis of the composition of the intestinal microbiota, it was noted that in the absence or suppression of lacto- and bifidoflora, the number and species diversity of microorganisms of the genera *Bacteroides*, *Clostridium*, *Collinsella*, *Eggerthella*, etc. literature [58]. The concept of functional redundancy has been validated in metagenomic studies. For example, in experimental models


**Table 1.**

*Values of some clinical laboratory test hematology and blood chemistry indicators in study and control groups.*

#### **Figure 1.**

*Quantitative characteristics of major components of the obligate intestinal microbiota in patients with chronic kidney disease receiving programmed hemodialysis.*

#### **Figure 2.**

*Occurrence rates for various species of the genus Bifidobacterium in patients with chronic kidney disease receiving programmed hemodialysis.*

#### **Figure 3.**

*Occurrence rates for various species of the normal human colon microbiota in patients with chronic kidney disease receiving programmed hemodialysis.*

*Specific Cerebrovascular Risk Factors, Colon Microbiocenosis and Its Correction in Patients… DOI: http://dx.doi.org/10.5772/intechopen.101300*

#### **Figure 4.**

*Occurrence rates for various species of the genus Bacteroides spp. in patients with chronic kidney disease receiving programmed hemodialysis.*

#### **Figure 5.**

*Dysbiotic disorders (grades I–III) of the colon microbiocenosis in patients with chronic kidney disease receiving programmed hemodialysis before starting treatment with symbiotic.*

[59], it was clearly shown how, on the one hand, functional redundancy and, on the other hand, metabolic "specialization" (production of lactate and acetate) of representatives of the two main bacterial phyla—Firmicutes and Bacteroides provide stability the gut ecosystem as a whole. However, in CKD, due to the progression of renal failure, the concentration of uremic toxins in the intra- and extracellular spaces increases, which leads to their influx into the gastrointestinal tract. With the help of bacterial urease, urea is quickly converted into ammonium hydroxide, irritating of the mucous membrane of the large intestine and, in the future, the development of inflammation. Approximately 68% of creatinine is transformed by bacteria into creatine, and the remainder is converted into 1-methylhydantoin, sarcosine, methylguanidine, etc., by the quantitatively prevailing proteolytic microorganisms (*B. fragilis*, *Bacteroides thetaiotaomicron*, *Enterobacter* spp., *Citrobacter* spp.) recognized as uremic toxins, which contribute to the aggravation of the manifestations of renal failure [21, 60].

Thus, in pathological conditions in humans, the mechanism of functional redundancy of the microbiota can lead to a worsening of the course of the disease [20]. As a result, the restoration of microbiocenosis with the help of undoubtedly probiotic microorganisms (lactobacilli and bifidobacteria) is of particular importance: proteolytic bacteria are excluded from the pathogenesis of the underlying disease formate and succinate) remains unchanged.

After complex therapy, both in the control group and in the group in which the synbiotic "LB-complex L" was used [9], bifidobacteria were detected in 100% of cases. However, in the main group, they were isolated mainly in amounts of 109–1010 CFU/g, while in the comparison group, their number was 107–108 CFU/g (*p* < 0.05). Lactobacilli were isolated in amounts of 107–108 CFU/g in 100% of patients in the main group and 56.25% of those examined from the comparison group. In 43.75% of patients in the comparison group, lactobacilli were absent in the microbiocenosis. Bacteroids were detected in 100% of the examined in the amount of 108–109 CFU/g in the main group and 106–107 CFU/g in the comparison group (*p* < 0.05).

In the main group, opportunistic microorganisms after treatment were detected with a lower frequency and in a smaller amount than in the comparison group. Thus, *Klebsiella* spp. was isolated in 6.25% versus 50.0% in the comparison group, *Citrobacter* spp.—in 12.5 and 56.25%, respectively. A similar trend was observed about other opportunistic microorganisms and fungi (*Raoultella* spp., *Enterococcus* spp., *Streptococcus* spp., *Acinetobacter* spp., *Corynebacterium* spp., *Microbacterium* spp., *Bacillus* spp., *Candida* spp., etc.). Thus, in the main group, 56% of the examined microbiocenosis recovered, grade III dysbiosis was not detected in any patient. In the comparison group, the microbiological indicators worsened: the number of cases of detection of pronounced microbiocenosis disorders of II and III degrees increased. In clinical and biochemical blood parameters of patients of the main group, attention is drawn to the decrease after treatment in the level of inflammation indicators—CRP (5.3 g/L) and ESR (36.2 mm/h).

The modern concept of providing medical care requires not only the restoration of the biological function of the body but also the normalization of its functioning. When assessing the quality of life using the SF-36 questionnaire, our study revealed an improvement in these indicators on the scales reflecting the physical component of health in the main group. The most positive dynamics after the treatment in the main group was noted on such scales of quality of life as RP—the scale of role activity due to a physical condition (before treatment: 39.2, after: 45.1); P, pain intensity scale (65.2 and 71.3, respectively) and GH, general health scale (52.6 and 58.8, respectively) (**Figure 6**) [60].

#### **Figure 6.**

*Dysbiotic disorders of colon microbiocenosis in patients with chronic kidney disease receiving programmed hemodialysis after treatment (a) main group; (b) comparison group.*

*Specific Cerebrovascular Risk Factors, Colon Microbiocenosis and Its Correction in Patients… DOI: http://dx.doi.org/10.5772/intechopen.101300*
