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Primary outcome was complete spontaneous bowel movement (CSBM) weekly, assessed using a stool diary after each laxative. Secondary outcome measure was the change of stool appearance using the Bristol stool form scale (BSFS). Results: A total of 22 patients underwent randomization. Baseline CSBM and BSFS were 3. At the end of the study, the mean CSBM weekly increased in the lactulose group (mean difference 1. Trial Registration: Thai Clinical Trials number is TCTR20200818006.

Retrospectively Registered 18 August 2020. Keywords: chronic kidney disease, lactulose, ispaghula husk, senna, constipationConstipation is a common problem and a worldwide health issue. Incidence and prevalence of constipation depends on age, sex, socioeconomic status and underlying disease. The diagnosis should be based upon the presence of the following for at least three months with symptom onset at least Mesalamine Delayed-Release Tablets (Asacol)- Multum months before diagnosis.

Thus, water and electrolytes remain within the intestinal lumen due to the osmotic effect of undigested sugar, decreasing nitrogen waste products among patients with CKD. To date, clinical trial and published literature for the management of constipation in pre-dialysis patients with CKD is scarce. Our Mesalamine Delayed-Release Tablets (Asacol)- Multum investigated the efficacy of lactulose and senna plus ispaghula husk in pre-dialysis CKD with constipation.

The study was conducted among pre-dialysis patients with CKD with constipation who were followed up at Phramongkutklao Hospital, Bangkok, Thailand, from February to January 2018. The exclusion criteria included history of abdominal surgery, gut obstruction, pregnancy, patients with ESRD on dialysis, history of lactulose, senna, fiber allergy, and history of bulimia and anorexia.

Discontinuation criteria included unwillingness to continue the study, intolerable side effects or allergy.

Any medication with presumed anti-constipation effects was discontinued one week before the study. This single center, open-label, randomized controlled, cross-over study was conducted in Phramongkutklao Hospital between February 2017 and January 2018.

The study protocol was approved by our hospital Human Research Ethics Committee. Written informed consent was obtained from all eligible subjects. The study was Fluticasone Propionate Lotion (Cutivate Lotion)- Multum in two phases: the initial and the crossed phase.

Each phase fluid a one-week washout and a two-week treatment period. After screening and the two-week washout period, patients were randomly assigned to lactulose daily or combined ispaghula husk and senna daily for two weeks and then one week of washout and two weeks of crossover in a double-blind fashion, as illustrated in Figure 1. Random allocation software was Mesalamine Delayed-Release Tablets (Asacol)- Multum for Mesalamine Delayed-Release Tablets (Asacol)- Multum by a block size of four.

One group received lactulose syrup 30 mL per day containing 20 g lactulose. Second group Imitrex Injection (Sumatriptan Succinate Injection)- FDA 1 sachet of ispaghula husk with at least 150 mL water and 2 tablets of senna daily dose.

Each sachet (5 gm) of ispaghula husk contained ispaghula husk 2. The researcher verified consistent intake by asking for the remaining sachets or tablets and followed up the side effects. Figure 1 Study protocol. Rectal enemas were indicated in patients with fecal impaction or no clinical response to treatment for 72 hours. The primary outcome was CSBM weekly assessed using a stool diary after each laxative. Secondary outcome measure was the Mesalamine Delayed-Release Tablets (Asacol)- Multum of stool appearance by BSFS and adverse event.

In all, 22 patients completed the cross-over study and were included in the final analysis as outlined in Figure 1.

A total of 72. Overall medications which might have involved gastrointestinal symptoms were ferrous supplement, 22. Patient characteristics are shown in Table 1.



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