Laxative Use in Patients With Advanced Chronic Kidney Disease Transitioning to Dialysis

Data are presented as number (percentage), mean (SD) or median (IQR). All P-values except peptic ulcer disease and anti-Parkinson drugs for between-group comparison were statistically significant.
^aBowel disorders include inflammatory bowel disease, irritable bowel syndrome and diarrhea.
RASi, renin–angiotensin system inhibitor.

Authors and Disclosures

Keiichi Sumida¹, Ankur A. Dashputre^1,2, Praveen K. Potukuchi^1,2, Fridtjof Thomas³, Yoshitsugu Obi¹, Miklos Z. Molnar^1,4–6, Justin D. Gatwood⁷, Elani Streja⁸, Kamyar Kalantar-Zadeh⁸ and Csaba P. Kovesdy<sup>1,9

1</sup>Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA, ²College of Graduate Health Sciences, Institute for Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, USA, ³Department of Preventive Medicine, Division of Biostatistics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA, ⁴James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA, ⁵Department of Surgery, Division of Transplant, University of Tennessee Health Science Center, Memphis, TN, USA, ⁶Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary, ⁷Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN, USA, ⁸Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California-Irvine, Orange, CA, USA and ⁹Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA

Correspondence to
Csaba P. Kovesdy; E-mail: ckovesdy@uthsc.edu

Authors' Contributions
K.S., A.A.D., P.K.P., F.T. and C.P.K. were responsible for study concept and design. K.S., A.A.D., P.K.P., M.Z.M., E.S., K.K.-Z. and C.P.K. were involved in data acquisition. K.S., A.A.D. and P.K.P. carried out data analyses. K.S., A.A.D., P.K.P., F.T., Y.O., M.Z.M., J.D.G., E.S., K.K.-Z. and C.P.K. were involved in data interpretation. K.K.-Z. and C.P.K. supervised the study. Each author contributed important intellectual content during manuscript drafting or revision and agreed to be accountable for all aspects of the work in ensuring that questions pertaining to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors reviewed and approved the final version of this manuscript.

Conflict of Interest Statement
None of the authors has relevant conflicts of interest.

Sidebar

Key Learning Points

What is already known about this subject?

• constipation is highly prevalent in patients with chronic kidney disease (CKD), particularly among those with end-stage renal disease (ESRD) receiving dialysis;

• pharmacological interventions are often required for the management of constipation in advanced CKD patients, and a wide range of laxative agents are currently available; and

• however, information is scarce on the prevalence and patterns of laxative use and its associated factors in patients with advanced CKD transitioning to ESRD.

What this study adds?

• the use of laxatives increased considerably (up to ~37%) as patients progressed to ESRD, and remained fairly stable after the transition to ESRD;

• the use of anticoagulants, oral iron supplements, non-opioid analgesics, antihistamines and opioid analgesics were among the factors independently associated with laxative use during the last 1-year period before transition to ESRD; and

• these results are likely mirroring the increasing burden of drug-induced constipation during the ESRD transition period, which may provide novel insight into better management strategies to alleviate constipation symptoms and reduce medication requirements in patients with advanced CKD.

What impact this may have on practice or policy?

• the high prevalence of laxative use in advanced CKD may help raise the awareness of prevalent constipation in this population, along with its contribution to health and economic burden;

• the identification of the medications associated with pre-ESRD laxative use may help detect previously under-recognized causes of drug-induced constipation and can help avoid unnecessary or inappropriate use of laxatives along with their unwanted adverse effects; and

• the potential changes in practice habits to avoid unnecessary laxative use could contribute to a lower overall pill and economic burden in this relevant population.