Chronic kidney disease (CKD) is a progressive loss of kidney function that can lead to end-stage renal disease (ESRD), requiring renal replacement therapy. Patients on chronic hemodialysis are at a higher risk of developing cardiovascular disease. This study aimed to investigate the effect of 12-week probiotic supplementation on insulin resistance, oxidative stress, and lipid profiles in diabetic patients with ESRD undergoing hemodialysis.