DISCUSSION
hypoalbuminemia, CKD, impaired kidney function, malnutrition, end-stage renal disease, decline of renal function, anorexia
HYPOALBUMINEMIA, ADVERSE EFFECTS, MALNUTRITION, END-STAGE RENAL DISEASE, ANOREXIA
This study investigated whether oral activated charcoal could adsorb uremic toxins and improve renal function tests in patients with end-stage renal disease undergoing regular hemodialysis. The process, known as “intestinal dialysis” occurs when urea and other waste products bind to charcoal and are excreted in the feces, creating a concentration gradient for continuous diffusion [The activated charcoal group showed a significant decrease in serum urea and phosphorus throughout the follow-up period. A study by Al-Shazly It is well known that the kidneys cannot excrete waste products such as urea and creatinine in end-stage renal disease. Instead, their excretion relies mainly on hemodialysis procedures [Regarding albumin levels, most end-stage renal disease patients suffer from hypoalbuminemia for several reasons, such as a low protein diet, protein loss through urine, and dialysate, especially with high flux filters. However, the current study found a non-significant decrease in albumin levels. This could be due to the frequent monitoring of albumin levels in both groups and intravenous albumin treatment was administered to patients with hypoalbuminemia. Additionally, the majority of dialysis patients suffer from malnutrition associated with anorexia and poor protein intake.Furthermore, the study revealed an increase in eGFR in the control group and a decrease in the activated charcoal group, but the changes did not reach significant levels in either group. These insignificant changes may be due to the need for longer durations of activated charcoal use to show beneficial effects or a larger sample size [The uremic toxin indoxyl sulfate is difficult to remove through regular hemodialysis, and even hemodiafiltration has limited success in removing it [The progressive decline of renal function in CKD leads to the accumulation of numerous uremic toxins, including indoxyl sulfate. This representative toxin builds up in the blood and tissues of patients with impaired kidney function [The current study has several limitations. Firstly, the sample size was restricted as only a small number of patients met the inclusion criteria out of 100 patients in the center. Secondly, the study was open-label due to concerns about black discoloration of stool, which may have influenced the tolerability and adverse effects. Thirdly, the study was novel, with few comparable studies or references. Finally, the study was conducted in a single center, and the results cannot be generalized to all centers treating hemodialysis patients in Iraq.