The objective of the pilot study is to validate a combined approach based on the use of an innovative symbiotic and an innovative dialysis cartridge in patients on hemodialysis (HD).

The symbiotic consists of a mixture of probiotics (Lactobacilli and Bifidobacteria), prebiotics (fructoligosaccharides and inulin) and natural antioxidants (a mix of quercetin, resveratrol and proanthocyanidins).

The cartridge is composed of a divinylbenzene (DVB) adsorbing resine, expected to have high affinity to protein-bound uremic toxins pCS and IS, on the basis of its chemical structure.

This combined approach will be aimed at achieving two main objectives:

1. reduction of blood levels of microbial-derived uremic toxins, involved in cardiovascular complications
2. reduction of inflammation markers and oxidative stress and reduction of intestinal permeability

Inclusion Criteria:

• CKD patients on bicarbonate hemodialysis
• Aged between 30 to 65
• BMI between 18.5 and 29.9
• Omnivore diet
• Informed consent signed

Exclusion Criteria:

• Use of antibiotics or probiotics up to 30 days prior to recruitment
• Chronic gastrointestinal disorders
• Systemic inflammatory diseases
• Suspicion or clinical diagnosis of malignancy
• Chronic liver disease
• Treatment with corticosteroids or immunosuppressive drugs
• Psychiatric conditions reducing the compliance to treatment protocols