Should Treating Constipation Be Part of A CKD Treatment Plan?

In a large nationwide study of 3.5 million US veterans, constipation was associated with kidney health and as a result, researchers are considering whether proper treatment of constipation could help treat or prevent kidney disease.

A visiting scholar at the University of Tennessee Health Science center in Memphis, TN, Keiichi Sumida, MD stated that in this study, there was a higher risk of having chronic kidney disease and end-stage renal disease amongst patients with constipation even after several other known risk factors have been controlled. It was also discovered that those with severe constipation were associated with an incrementally higher risk of CKD and ESRD.

The findings of the American Society of Nephrology’s Kidney Week 2016 meeting were presented by Dr. Sumida in the form of a poster.

A multivariable analysis was performed and those who were constipated had approximately 13% higher chance of having CKD and a 9% higher chance of developing ESRD. It was also observed that those with constipation had a faster decline in the estimated glomerular filtration ratio (eGFR).

About 4.5 million patients with serum creatinine measurements acquired between October 2004 and September 2006 were identified through scrutiny of US Veterans Administration databases. About 3.5 million of them had eGFR higher that 60ml/min/1.73m2 and no other CKD symptom. They were all followed through 2013.

Constipation was described as a minimum of 2 ICD-9-CM diagnoses for constipation done at least 2 months apart or at least 2 prescriptions for laxatives separated by 60 days for up to a year. The number of the different types of laxatives prescribed was a factor based upon the severity of the constipation and an absence of constipation that responded to laxatives. Mild constipation responded to one laxative while 2 or more laxatives were indicative of more severe constipation.

Co-primary outcomes were incident ESRD, incident CKD as well as a change in eGFR from the baseline. Just as predicted in the susceptibility-matched cohort, clinical characteristics and baseline demographics were similar for the 3.5 million people who experienced constipation and the 253,441 that didn’t.

Dr. Sumida went on to say that the plausible link between the kidney and the gut has been highlighted by the discoveries and additional insights into pathogenesis of kidney progression has been explored. From the reports, it is safe to say that there should be a careful observation of the kidney function in patients that have constipation, especially the ones with more severe constipation.

He hypothesized that a distorted gut microflora on constipation may lead to inflammation, accumulation of toxins and changes in metabolites. Alternative elucidations augmented serotonin associated with the use of laxative, dehydration, nephrotoxicity, or electrolyte imbalance.

These have to be looked into, as does the notion that relieving constipation could prevent renal decline. Dr. Sumida also stated that “based on the high levels of constipation in the general population, as well as the ease of its primary care assessment, the management of constipation via the use of probiotics and lifestyle change instead of laxatives could be an effective tool in the prevention of CKD.

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