 Improving the poor prognosis of ESRD patients is an ongoing challenge. An increased awareness of the limitations in conventional dialysis techniques has renewed interest in alternative therapeutics in recent years. An unmet clinical need for adjuvant therapeutic strategies persists in patients whether renal transplantation is intended or not. Supplementation of probiotics and thereby targeting the intestine, an important source of endotoxin and uremic toxins, might be a promising approach to partly overcome the high morbidity and mortality in ESRD patients. Probiotics are living beneficial microorganisms, able to gastroduodenal passage and maintain viability throughout the gut. Feasibility of gut microbiome modulation in ESRD was shown in animal and human settings. However, so far, it is unknown to what extend probiotics are able to re-establish gut microbiome homeostasis in ESRD. Furthermore the effects of a probiotic intervention on cardiovascular risk factors, inflammation, gut barrier and uremia have not been studied in detail yet. 