Lactulose Therapy for Chronic Renal Failure

Abstract

The enteric excretion of nitrogen compounds has been used as a therapy for chronic renal failure. To stimulate the enteric excretion of nitrogen compounds, we administered lactulose (4-o-β-D-galactopyranosyl-α-D-fructose) to the patients with decreased renal function. Lactulose, which is said to inhibit the enterohepatic circulation of urea, has been used to decrease the plasma concentration of ammonia in the patients with hepatic coma. The patients were placed on a standard diet containing 50 g of protein and 10 g of sodium chloride for two weeks. Then they were administered 65% lactulose solution (30-60 ml/day) orally enough to cause loose bowels, and were observed for the following two weeks. There were no remarkable changes in body weight or blood acid-base balance. No adverse effects were demonstrated in this study. The ratio of BUN/S-creatinine decreased significantly. In the ten patisnts whose serum concentration of creatinine were 3.0-7.0mg/dl, the serum concentration of urea, guanidinosuccinic acid (GSA), methylguanidine (MG) and phosphate decreased significantly. In the five patients who had clinical manifestations of uremia at ahe beginning of this therapy with a creatinine concentration over 7.0 mg/dl, the ratio of BUN/S-creatinine also decreased by lactulose therapy, but the serum concentration of GSA and MG increased progressively. of urea, results indicated that lactulose decreased the serum concentration of, GSA, MG and phosphate, and suggested that lactulose may be useful for the therapy of chronic reanl failure.