Objectives: The aim of this study is to investigate the effect of synbiotics (composition of Bifidobacterium and Lactobacillus and complex fiber), probiotic (Bifidobacterium and Lactobacillus) and placebo supplementation on renal function (GFR), systemic (hs-CRP, IL-6 ) and vascular (ICAM-1 and VCAM-1) inflammations, endotoxin, HSP 70 antibody and cytokeratin 18 (k-18) in hemodialysis patients design: In this double-blind randomized controlled trial, 75 male and female hemodialysis patients aged 65-30 years old, who are eligible for inclusion in the study will be recruited from hemodialysis ward of Ahwaz Imam Khomeini hospital. After obtaining Informed consent form all participants at the beginning of the study, Participants randomly allocated in three groups, receiving daily supplementation of synbiotics, probiotics or placebo for 8 weeks. Before starting dialysis, Blood and stool samples will be collected at the beginning and end of study. All anthropometric and physical activity variables will be measured both before and after the trial. To assess the dietary factors, the total amount of energy, macronutrients and micronutrients intake will be determined at the beginning and the end of the study. For this purpose 3-days 24-hour dietary recall will be completed by the patients and will be evaluated. Finally data will be analyzed by N4 software. Diets and medications dosage will be held constant throughout the study and each subject’s exercise level will be kept constant and monitored by physical activity questionnaires (IPAQ).