Clinical factors associated with constipation in hemodialysis patients

Ikee, Ryota; Toyoyama, Takayuki; Endo, Toko; Tsunoda, Masataka; Hashimoto, Nobuo

doi:10.1007/s11255-016-1363-3

Cited by 12 publications

(16 citation statements)

References 9 publications

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“…On the other hand, Yamada et al showed that peripheral neuropathy of the lower extremities correlated with the symptoms of constipation, irrespective of the presence of diabetic nephropathy or retinopathy [51]. In our previous study including 136 HD patients, DM was independently associated with constipation defined by laxative use [28].…”

Section: Comorbiditiesmentioning

confidence: 63%

“…Decreased fluid intake has been implicated as a cause of constipation in dialysis patients. However, we previously reported no significant differences in interdialytic weight gain between patients with and without constipation [28]. Wu et al showed that interdialytic weight gain correlated with a longer colonic transit time [15].…”

Section: Dietary Restrictionsmentioning

confidence: 73%

“…Thus, stools that remain in the colon longer become drier and harder. However, laxatives are regularly administered to a substantial proportion of CKD patients [15,27,28] and strongly affect stool frequency and consistency. The cessation of laxatives in order to diagnose constipation is troublesome in clinical practice.…”

Section: Prevalence Of Constipation In Ckdmentioning

confidence: 99%

“…The cessation of laxatives in order to diagnose constipation is troublesome in clinical practice. Tables 3 and 4 show the prevalence of constipation reported in nondialysis-CKD patients [29,30] and dialysis patients [15,[27][28][29][31][32][33][34][35][36], respectively. Cano et al reported a higher prevalence of constipation in dialysis patients in a comparison with age and sex-matched community subjects (31.1% vs. 10.1%, P < 0.001) [32].…”

Section: Prevalence Of Constipation In Ckdmentioning

confidence: 99%

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Constipation in chronic kidney disease: it is time to reconsider

Ikee

Yano

Tsuru³

2019

Ren Replace Ther

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Constipation is highly prevalent in patients with chronic kidney disease (CKD) and is primarily characterized by decreased intestinal motility. This chronic disorder affects the quality of life of patients. However, nephrologist and dialysis clinicians have long had a disproportionately limited understanding of constipation. Accumulating evidence has revealed a relationship between constipation and cardiovascular disease and CKD. The pathogenesis of constipation in CKD patients is multifactorial: decreased physical activity, comorbidities affecting bowel movement, such as diabetes mellitus, cerebrovascular disease, and hyperparathyroidism, a restricted dietary intake of plantbased fiber-rich foods, and multiple medications, including phosphate binders and potassium-binding resins, have all been implicated. CKD is associated with alterations in the composition and function of the gut microbiota, socalled gut dysbiosis. Recent studies showed that CKD-related gut dysbiosis decreased intestinal motility via intestinal inflammation or the increased generation of gut-derived uremic toxins, such as indoxyl sulfate and pcresyl sulfate. Furthermore, the gastrointestinal secretion of mucin was found to be decreased in CKD animal models, which may delay colonic transit by diminished lubrication in the alimentary tract. Thus, CKD-related gut dysbiosis may play a role in constipation, but limited information is currently available. Since constipation is often intractable, particularly in CKD patients, every available means needs to be employed in its treatment. The effects of probiotics, prebiotics, and synbiotics on the composition of the gut microbiota and gut-derived uremic toxins have been increasingly reported. However, their effects on stool consistency or frequency in CKD patients remain unclear. Some laxatives may be beneficial for improving not only bowel habits but also gut dysbiosis. Further studies are required to elucidate the CKD-specific pathogenesis of constipation and develop novel effective treatment options.

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Section: Comorbiditiesmentioning

confidence: 63%

Section: Dietary Restrictionsmentioning

confidence: 73%

Section: Prevalence Of Constipation In Ckdmentioning

confidence: 99%

Section: Prevalence Of Constipation In Ckdmentioning

confidence: 99%

See 2 more Smart Citations

Constipation in chronic kidney disease: it is time to reconsider

Ikee

Yano

Tsuru³

2019

Ren Replace Ther

Self Cite

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“…The prevalence of constipation requiring laxative therapy is high in ESRD patients [79,80]. Mg-containing laxatives may be used to concurrently treat constipation and hypomagnesemia.…”

Section: Mg-containing Laxativesmentioning

confidence: 99%

Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions

Ikee¹

2018

Ren Replace Ther

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Magnesium (Mg) is an essential element that plays pivotal roles in a number of biological processes in the human body. Hypomagnesemia is involved in the pathophysiology of hypertension, vascular calcification, and metabolic derangements including diabetes mellitus and dyslipidemia, which are all risk factors for cardiovascular disease, the leading cause of mortality and morbidity in patients with chronic kidney disease (CKD). Hypomagnesemia is also associated with the development and progression of CKD. As CKD advances, renal Mg excretion decreases and hypermagnesemia emerges in end-stage renal disease (ESRD). In addition, dialysates with high Mg concentrations, which were used in the early era of dialysis therapy, increased the risk of hypermagnesemia, and thus, the dialysate Mg composition has since been reduced. Accordingly, dialysis patients in the modern era commonly have normomagnesemia or even hypomagnesemia. The relationships between hypomagnesemia and cardiovascular disease and mortality have been increasingly reported in observational studies in CKD/ESRD. However, these relationships may be attenuated by a patient's race or region. Although dialysates with higher Mg concentrations or Mg-containing phosphate binders appear to be promising in this setting, only a few interventional studies have examined the effects of Mg supplementation on cardiovascular lesions. Furthermore, the effects of Mg supplementation on mortality have not yet been investigated as a primary end-point in randomized controlled trials. Further studies are required in order to establish the efficacy and safety of Mg in CKD patients.

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Constipation in CKD

Sumida

Yamagata

Kövesdy

2020

Kidney International Reports

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Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for constipation, some of which showing unique renoprotective properties, the adequate management of constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.

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Clinical factors associated with constipation in hemodialysis patients

Cited by 12 publications

References 9 publications

Constipation in chronic kidney disease: it is time to reconsider

Constipation in chronic kidney disease: it is time to reconsider

Cardiovascular disease, mortality, and magnesium in chronic kidney disease: growing interest in magnesium-related interventions

Constipation in CKD

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