Gut Microbiome and p-Inulin in Hemodialysis

Inclusion Criteria: * Maintenance hemodialysis therapy for end-stage renal disease * At least 18 years of age * At least 90 days since hemodialysis initiation * Self-reported average stool frequency of at least 1 every other day * For women of childbearing potential, willingness to use a highly effective method of birth control for up to 4 weeks after the last dose of p-inulin. * Ability to provide consent Exclusion Criteria: * Use of prebiotics or probiotics during the past 8 weeks * Consumption of probiotic yogurt during the past 2 weeks * Use of antibiotics within the past 8 weeks * Presence of HIV infection, chronic wound infection, osteomyelitis, or current hemodialysis * Inflammatory bowel disease, chronic diarrhea, current C. difficile infection * Cirrhosis or chronic active hepatitis * Anticipated kidney transplantation, change to peritoneal dialysis, or transfer to another dialysis unit within 9 months * Expected survival less than 9 months * Pregnancy, anticipated pregnancy, or breastfeeding * Incarceration * Participation in another intervention study * Severe anemia defined as hemoglobin \<9.0 g/dl within the past 4 weeks as documented in the dialysis unit patient record