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206 In a placebo-controlled trial, 60 patients with stage 4 CKD who had been eating a low-protein diet for two months were assigned to add probiotic supplements providing 1 billion CFUs L

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Monitoring and follow-up Monitor clinically and repeat tests as indicated by the underlying condition Ongoing monitoring of liver function, renal function, and FBC as clinically indicated Regular review in primary care or specialist clinics for underlying conditions Patient advice: Patients should understand that elevated B12 is a marker requiring investigation rather than a condition requiring direct treatment

Schermer T, Chavannes N, Dekhuijzen R, Wouters E, Muris J, Akkermans R, van Schayck O, van Weel C