Prevalence and Severity of Lower Gastrointestinal Symptoms amongst Non-Dialysis Chronic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Abstract

Chronic kidney disease (CKD) patients experience a wide range of symptoms that deteriorate their health-related quality of life (HRQoL). We aimed to estimate the prevalence and severity of lower gastrointestinal (GI) symptoms in non-dialysis CKD adult outpatients, and to summarize the relationships between these symptoms and HRQoL, laboratory test results, and clinical data. The protocol of the study was preregistered (PROSPERO CRD42021255122). We searched MEDLINE, Scopus, Web of Science, and grey literature sources from the databases’ inception up until 27 November 2021. Wide citation chasing was conducted. Single proportions (prevalence of functional constipation, self-reported constipation, diarrhea, abdominal bloating, fecal incontinence, and abdominal/rectal pain) were pooled using generalized linear mixed models. A total of 37 studies with 12,074 patients were included. We found that lower GI symptoms, especially self-reported abdominal bloating [CKD G1–2: 48.45% (95% CI: 43.5–53.4%; 2 studies); G3: 46.95% (95% CI: 45.0–48.9%; 2 studies), G4–5: 36.1% (95% CI: 25.4–48.5%; 8 studies)] and constipation [CKD G1–2: 31.8% (95% CI: 13.9–54.9%); G3: 29.8% (95% CI: 21.2–40.1%; 4 studies); G4–5: 38.8% (95% CI: 30.9–47.4%); 22 studies)], were common in non-dialysis CKD patients. The severity of the symptoms was limited. Self-reported constipation was most consistently associated with worse HRQoL, whereas hard stool consistency was associated with higher uremic toxins levels. To conclude, since lower GI symptoms are common in CKD, using symptom questionnaires that do not take them into account cannot provide full insight into the patient’s experience. Further studies are needed to cover identified knowledge gaps, including the exploration of the pathophysiology of GI symptoms in CKD with multi-omics data.

Real-world evidence of constipation and laxative use in the Korean population with chronic kidney disease from a common data model

“…To date, only a small number of studies have examined the prevalence of constipation in patients with non-dialysis CKD. A recent meta-analysis reported the pooled prevalence of self-reported and functional constipation in different CKD stages 8 . The prevalence of self-reported and functional constipation in patients with CKD stage 4–5 was 38.78% and 21.97%, respectively.…”

“…Although the global prevalence of constipation in the general population has been estimated at approximately 14%, the prevalence in patients with CKD is reported to be much higher 7 . A recent metaanalysis reported a constipation prevalence of 38.8% in patients with advanced non-dialysis CKD 8 . Patients with end-stage kidney disease (ESKD) have been shown to have a substantially higher constipation prevalence, with some studies reporting over 50% 9 .…”

“…Despite these observations, most research topics on constipation in patients with CKD remain unexplored. The exact prevalence and incidence rates of constipation in patients with CKD remain undetermined; most studies involved a relatively small number of participants, often less than 100 8 . The detailed characteristics and epidemiological data on constipation in patients with CKD are largely unknown.…”

Bowel habits were associated with mortality in chronic kidney disease: results from a nationwide prospective cohort study

“…discovered a high occurrence of constipation among non-dialysis CKD patients, with prevalence rates of 31.8% in CKD stage 1–2, 29.8% in CKD stage 3, and 38.8% in CKD stage 4–5 [ 5 ]. They also observed that self-reported constipation consistently correlated with poorer health-related quality of life, while the presence of hard stool consistency was linked to elevated levels of uremic toxins [ 5 ]. In CKD patients undergoing dialysis, the gastrointestinal symptoms that were found to be most prevalent included constipation, indigestion, abdominal pain, and reflux.…”