INTRODUCTION
CKD, chronic kidney disease, uremia, primary kidney disease, azotemia, loss of functional nephrons, ESRD, systemic disorders, hypertension, acute kidney injury
UREMIA, HYPERTENSION, INFLAMMATION, DISEASE, AZOTEMIA, DIABETES MELLITUS, RENAL DISEASE, SECONDARY, SYNDROME, CHRONIC KIDNEY DISEASE (CKD), END-STAGE RENAL DISEASE, BLOOD, ESRD, COMPLICATIONS
Chronic kidney disease (CKD) is a non-reversible and progressive disease affecting the kidneys, significantly impacting global public health. One of the complications of chronic kidney disease is impaired intestinal barrier function, which may allow harmful products such as urea to enter the bloodstream and cause systemic inflammation. This study aimed to investigate whether supplementation with activated charcoal could reduce uremic toxins in patients with end-stage renal disease (ESRD). The study was a randomized clinical trial conducted at the Dialysis Center of al Diwaniyah Medical Hospital in the Diwaniyah Governorate. Eighty-two patients with ESRD on regular hemodialysis were enrolled, with 15 patients receiving oral supplementation with activated charcoal in addition to standard care and 13 patients receiving only standard care. Blood samples were collected at baseline and after eight weeks, and several biomarkers were measured, including estimated glomerular filtration rate (eGFR), creatinine, urea, phosphorus, albumin, and indoxyl sulfate. The results showed a significant reduction in both serum urea and serum phosphorus levels after eight weeks of oral-activated charcoal treatment. However, the other biomarkers were not affected by the treatment. In conclusion, the use of oral-activated charcoal for eight weeks in Iraqi patients undergoing maintenance hemodialysis improved urea and phosphorus levels.Chronic kidney disease (CKD) is a progressive and irreversible syndrome that results in an inability to maintain metabolic, fluid, and electrolyte balance, thereby causing uremia or azotemia [In CKD, there is a gradual loss of functional nephrons, which can be caused by primary kidney disease or secondary complications arising from systemic disorders, such as hypertension or diabetes mellitus. In addition, acute kidney injury can cause irreversible damage. In CKD, the colon adapts, assuming the role of the primary excretory organ responsible for maintaining bodily homeostasis. However, this adaptation can have severe effects on the gut environment. In individuals with CKD, serum urea accumulates, leading to an increased presence of urea within the intestinal lumen. Urease-producing bacteria then hydrolyze urea into ammonia and ammonium hydroxide, which increases intestinal pH, mucosal irritation, and structural changes to the gut barrier [Activated charcoal operates as an adsorbent within the gastrointestinal (GI) tract, effectively trapping various chemicals. These captured substances are then retained within the charcoal matrix, preventing or reducing their absorption into the bloodstream [Activated charcoal and protein-limited diets are utilized to manage uremic symptoms in patients with diverse stages of renal disease. Through binding with urea and other urine toxins, activated charcoal effectively eliminates them via the feces [Studies have been carried out to reduce the flow of uremic toxins from the gut to slow the progression of CKD [