Lubiprostone, a novel laxative, might improve hyperphosphatemia without water dilution

Gen, Shiko; Nobe, Kanako; Ikeda, Naofumi

doi:10.1186/s41100-016-0064-9

Cited by 10 publications

(8 citation statements)

References 9 publications

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“…However, in this study, the LDL and HDL levels did not change significantly after elobixibat administration for 4 weeks. Although lubiprostone was reported to decrease serum IP levels in hemodialysis patients [30], electrolytes did not change significantly in this study. The present study had several limitations.…”

Section: Discussioncontrasting

confidence: 63%

Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study

Kamei

Nagano

et al. 2020

BMC Gastroenterol

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Background: Hemodialysis patients are prone to constipation, which can adversely affect their quality of life (QOL). Elobixibat, a highly selective inhibitor of the ileal bile acid transporter, can increase the bile acid level in the colon and, subsequently, enhance colonic motility and secretion. In hemodialysis patients with chronic constipation, it may have a novel action mechanism. However, the effect of elobixibat on such patients' QOL had not been reported. This study aimed to evaluate the effect of elobixibat on the QOL of hemodialysis patients with chronic constipation.Methods: This was a multicenter, observational study that used the Japanese version of the Patient Assessment of Constipation-Quality of Life (PAC-QOL) questionnaire on 27 patients (18 men and nine women, age range 47-90 years), who satisfied the Rome 3 diagnostic criteria for functional constipation and were already taking other drugs for constipation. These patients were administered elobixibat 10 mg/day and were asked to respond to the PAC-QOL questionnaire at baseline and after 4 weeks. Bayesian statistics were used to confirm our results. Results: The number of spontaneous bowel movements per week increased significantly from 2.6 ± 1.2 to 4.1 ± 2.1 (p < 0.001), and the Bristol Stool Form Scale score significantly improved from 1.9 ± 0.8 to 3.6 ± 0.7 (p < 0.001). The Cronbach's alpha was 0.95, and the Guttman split-half reliability coefficient was 0.90. There were significant decreases in the physical discomfort scores from 1.94 ± 0.79 to 0.97 ± 0.72 (p < 0.001); psychosocial discomfort from 1.16 ± 0.93 to 0.63 ± 0.58 (p < 0.001); worries/ concerns from 1.84 ± 0.73 to 1.27 ± 0.59 (p < 0.001), and satisfaction from 2.79 ± 0.61 to 1.98 ± 0.77 (p < 0.001). The total PAC-QOL score significantly decreased from 1.83 ± 0.79 to 1.17 ± 0.56 (p < 0.001). Bayesian statistics confirmed the results' significance. Conclusions: Elobixibat reduced the PAC-QOL scores for hemodialysis patients with chronic constipation and improved the patients' QOL. It may serve as a new option for treating constipation in hemodialysis patients.

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Section: Discussioncontrasting

confidence: 63%

Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study

Kamei

Nagano

et al. 2020

BMC Gastroenterol

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“…Lubiprostone may improve the prognosis of hemodialysis patients through bowel control and decreases in serum Pi [30]. These findings also suggest that improving the gut environment might be associated with a decrease in Pi, resulting in a decrease in iPTH.…”

Section: Discussionmentioning

confidence: 90%

“…First, the study used a rat model of CKD model and not patients with CKD; therefore, results cannot be generalized to humans. Second, to our knowledge, few reports have suggested that improvement in the gut environment is associated with a decrease in Pi [28, 30]. Third, colon samples were not evaluated in this study, so we could not discuss epithelial barrier impairment in uremia [39].…”

Section: Discussionmentioning

confidence: 99%

Dietary Changes Involving Bifidobacterium longum and Other Nutrients Delays Chronic Kidney Disease Progression

et al. 2018

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Background: Recent studies suggest that prebiotic and/or probiotic treatments ameliorate kidney function in humans and animals by improving the gut environment. However, the gut microbiota and kidney disease interactions remain to be determined. This study investigated whether synbiotics modulate the gut microbiota and ameliorate kidney function using a rat model of chronic kidney disease (CKD). As uremic toxins are associated with CKD-related mineral and bone disorder, the secondary aim was to evaluate the relationship between synbiotics and secondary hyperparathyroidism (SHPT). Methods: 5/6 nephrectomy (Nx) rats were developed as the CKD model. Sham-operated (sham) rats were used as the control. To investigate the effectiveness of prebiotics (glutamine, dietary fiber, and oligosaccharide) and probiotics (Bifidobacterium longum strain; GFOB diet), rats were randomly assigned to 4 groups: Nx group fed the GFOB diet (n = 10); Nx group fed the control (CON) diet (n = 10); sham group fed the GFOB diet (n = 5); and sham group fed the control diet (n = 5). Blood, feces, and kidney samples were collected and analyzed. Results: Serum creatinine (Cre) and blood urea nitrogen in the Nx GFOB group were significantly lower than those in the Nx CON group. Serum indoxyl sulfate in the Nx GFOB group was lower than that in the Nx CON group, and significantly correlated with serum Cre. Inorganic phosphorus and intact parathyroid hormone in the Nx GFOB group were significantly lower than those in the Nx CON group. Conclusion: Improving the gut environment using synbiotics ameliorated kidney function and might be a pharmacological treatment for SHPT without any serious adverse events.

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“…Lubiprostone is a chloride channel activator that increases water secretion into the intestinal lumen and enhances colonic transit. In HD patients, lubiprostone was reported to increase stool frequency significantly from 1.8 ± 1.3 to 4.5 ± 1.5 times/week [87]. It is notable that this agent increased gastric and intestinal mucin secretion [88,89], potentially leading to lubrication of the alimentary tract [69,89].…”

Section: Laxativesmentioning

confidence: 99%

“…As described above, bile acids cause fluid secretion and enhance colonic motor activity [56]. Gen et al reported a decrease in serum phosphate after lubiprostone therapy [87]. Accelerated intestinal transit may reduce phosphate absorption in the small intestine.…”

Section: Laxativesmentioning

confidence: 99%

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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Lubiprostone, a novel laxative, might improve hyperphosphatemia without water dilution

Cited by 10 publications

References 9 publications

Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study

Elobixibat alleviates chronic constipation in hemodialysis patients: a questionnaire-based study

Dietary Changes Involving <b><i>Bifidobacterium</i></b> <b><i>longum</i></b> and Other Nutrients Delays Chronic Kidney Disease Progression

Constipation in chronic kidney disease: it is time to reconsider

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