A Comparative Study of Reno-protection with Combination of N-acetylcysteine and Keto Analogs Versus Probiotics and Keto Analogs in Predialytic Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is a condition that deteriorates over time and causes the loss of nephrons, leading to impaired kidney function and finally bringing on end-stage renal disease (ESRD). As the world’s 12th biggest cause of mortality, CKD presents a serious public health concern, with an exceptionally high prevalence of diabetic nephropathy among diabetic patients. The economic burden of ESRD, especially in the context of renal replacement therapy, is substantial and can be financially challenging for patients. Oxidative stress is recognized as a prominent and advancing factor in CKD, irrespective of its underlying causes. Imbalances in gut microbiota have also been associated with CKD, potentially exacerbating its progression. Elevated urea levels in CKD patients can compromise the integrity of the gut epithelial barrier, permitting the entry of bacterial toxins into the bloodstream and consequently triggering systemic inflammation. This inflammatory milieu, along with microbiota imbalances, can contribute to increased oxidative stress, heightened susceptibility to infections, immunological dysfunction, and insulin resistance, all of which negatively impact the prognosis of CKD. Objectives: The purpose of this research is to postpone the progression of CKD to lower the risk of ESRD, eventually improving the quality of life for impacted patients. The study utilizes creatinine and glomerular filtration rate (GFR) as markers to assess CKD progression and renal function. The research aims to compare the reno-protective efficacy of two treatment regimens: N-acetylcysteine with keto analogs instead of probiotics and keto analogs in individuals with predialytic CKD receiving care in a nephrology department. Materials and Methods: A prospective observational study was carried out for 6 months in a nephrology department of a super specialty hospital. Patient data were collected from case sheets and through history interviews. Categorical variables were analyzed using frequencies and percentages. Results: Following the application of the inclusion criteria, 50 patients were chosen for the investigation. While there was significant variation in age and CKD stages between the two groups, no significant gender differences were observed. Statistically significant differences were identified between the research groups concerning the percentage reduction in creatinine and improvements in GFR. Conclusion: The study’s outcomes show that probiotics and keto analogs work well together for patients with and without diabetes, especially those with severe CKD. Conversely, combining N-acetylcysteine with keto analogs appears to be more effective in early CKD stages. A noteworthy negative correlation was observed between creatinine and GFR in patients receiving the probiotic and keto analogs combination compared to those receiving N-acetylcysteine and keto analogs.