Renal failure following bowel cleansing with a sodium phosphate purgative

Rose, Martin; Karlstadt, Robyn G.; Walker, Kelli

doi:10.1093/ndt/gfh908

Cited by 14 publications

(7 citation statements)

References 7 publications

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“…A recent literature review revealed an increasing number of reports that have continued to implicate the concurrent use of ACEIs and/or ARBs in the causation and aggravation of AKI on CKD patients following certain specific common procedures [115,116,117,118,119,120,121,122]. These procedures include postoperative states such as following gastric bypass surgery [115], after cardiac surgery [118] and following the use of oral phosphate sodium preparations for lower bowel preparations [116,117,120,121,122] (table 2).…”

Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

“…These procedures include postoperative states such as following gastric bypass surgery [115], after cardiac surgery [118] and following the use of oral phosphate sodium preparations for lower bowel preparations [116,117,120,121,122] (table 2). In a study of 504 patients who underwent gastric bypass surgery, preoperative use of ACEIs or ARBs (OR 2.06; 95% CI 1.05–4.04) was associated with increased frequency of AKI [115].…”

Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

“…Additionally, the perioperative use of ACEIs/ARBs has recently been demonstrated to be significantly associated with an increased risk for AKI after cardiac surgery in 2 tertiary medical centers in Buffalo, New York [118]. Based on these reports [115,116,117,118,119,120,121,122], and taken together with our single-center experiences, we have proposed that the prophylactic withholding of ACEIs and/or ARBs, during acute illness, in the perioperative period, and prior to contrast exposure, should become standard of care, to limit the impact of AKI in CKD patients [55,56,77]. We coined the term renoprevention to encompass these practices [55,56].…”

Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

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Can ACE Inhibitors and Angiotensin Receptor Blockers Be Detrimental in CKD Patients?

Onuigbo

2011

Nephron Clin Pract

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Current epidemiological data from the USA, Europe, Asia and the Indian subcontinent, Africa, the Far East, South America, the Middle East and Eastern Europe all point to the increasing incidence of renal failure encompassing acute kidney injury (AKI), chronic kidney disease (CKD) and end-stage renal disease (ESRD). While the explanations for these worldwide epidemics remain speculative, it must be acknowledged that these increases in AKI, CKD and ESRD, happening worldwide, have occurred despite the universal application of strategies of renoprotection over the last 2 decades, more especially the widespread use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). We note that many of the published large renin-angiotensin-aldosterone system (RAAS) blockade randomized controlled trials, upon which current evidence-based practice for the increasing use of ACEIs and ARBs for renoprotection derived from, have strong deficiencies that have been highlighted over the years. From reports in the literature, there is an increasing association of exacerbations of renal failure with ACEIs and ARBs, more so in the older hypertensive patient, >65 years old. The biological plausibility for ACEI and ARB to protect the kidneys against a background of potential multiple pathogenetic pathways to account for CKD progression appears to be not very defensible. We reviewed the literature along these lines and submit that ACEIs and ARBs often cause unrecognized significant worsening renal failure in CKD patients, sometimes irreversible, and that more caution is required regarding their use, especially in the older hypertensive patients, with likely ischemic hypertensive nephropathy. Given the increasing association of concomitant RAAS blockade with worsening renal failure following exposure to iodinated contrast, during acute illness, in the perioperative period and following lower bowel preparations prior to colonoscopy, we submit that, preferably, ACEIs and ARBs be withheld for 2–4 days prior to or during these clinical scenarios. This represents the concept of renoprevention.

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Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

Section: Raas Blockade and Aki In Specific Clinical Syndromesmentioning

confidence: 99%

See 1 more Smart Citation

Can ACE Inhibitors and Angiotensin Receptor Blockers Be Detrimental in CKD Patients?

Onuigbo

2011

Nephron Clin Pract

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“…[13][14][15][16][17][18][19][20][21][22][23][24] In addition, Jones et al, in 2005, concluded after a review of the diabetic/CKD literature and simultaneous ESRD trends that the diabetic epidemic accounted only for 10% of the new ESRD epidemic in the United States. [33][34][35][36] Moreover, drug-induced ARF, including use of ACEIs and ARBs, was reported to account for an increasing proportion of ARF among patients in 2 Jordanian hospitals in a recent analysis from the Middle East. 26 Furthermore, Suissa et al concluded from a population-based historical cohort analysis of 6102 diabetic patients in Canada that after 3 years or longer of ACE inhibition, there was an increased rate ratio of ESRD of 4.2 (95% confidence interval [CI]: 2.0-9.0).…”

Section: Introductionmentioning

confidence: 99%

“…32 Besides, among CKD patients who develop nephrotoxicity from oral phosphate sodium during bowel preparations, the use of these agents has been associated with worse renal outcomes. [33][34][35][36] Moreover, drug-induced ARF, including use of ACEIs and ARBs, was reported to account for an increasing proportion of ARF among patients in 2 Jordanian hospitals in a recent analysis from the Middle East. 37 Anecdotally, our suburban 4-physician nephrology practice, serving a population of about 100,000 with another nephrology group, has, in recent years, noticed an increasing incidence and severity of cases of ARF among hospitalized patients concurrently receiving an ACEI, an ARB, or a combination of both.…”

Section: Introductionmentioning

confidence: 99%

Does concurrent renin‐angiotensin‐aldosterone blockade in (older) chronic kidney disease patients play a role in the acute renal failure epidemic in US hospitalized patients?—Three cases of severe acute renal failure encountered in a northwestern Wisconsin Nephrology practice

Onuigbo

2009

Hemodialysis International

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Following the publication of several large multicenter randomized placebo-controlled trials showing reno-protection with renin-angiotensin-aldosterone (RAAS) blockade, the last 2 decades have witnessed an escalating use of the angiotensin-converting enzyme inhibitors and the angiotensin receptor blockers. Simultaneously, we continue to experience an increasing epidemic of acute renal failure (ARF) both in community-based and in hospital-based studies. Even though other factors would be contributing to this ARF epidemic, recent published data have raised concerns of a plausible connection between increased use of the RAAS blocking agents and this ARF epidemic. In our 4-nephrologist northwestern practice, we have, in recent years, anecdotally encountered an increasing number and severity of ARF, often with hyperkalemia, sometimes requiring dialysis intervention, in patients concurrently on these agents. Over the 3-day Christmas weekend in 2007, we treated 3 cases of severe ARF (peak serum creatinine of 7.0 (3.3-9.2) mg/dL), all on RAAS blockade. Renin-angiotensin-aldosterone blockade was promptly discontinued. All patients received intravenous fluid repletion. Kidney function rapidly normalized in 2 within 1 week. One patient required hemodialysis for 14 days before his serum creatinine returned to normal after 5 weeks. All 3 patients have continued to maintain baseline serum creatinine several months later, still off RAAS blockade. The mean baseline eGFR for the 3 patients was 46 (41-51) mL/min/1.73 m(2) body surface area. This phenomenon of ARF exacerbation, which may have implications for chronic kidney disease progression to ESRD especially in the elderly, merits further study. We support the recommendation that (older, >65 years old) chronic kidney disease patients on RAAS blocking agents should have the medications temporarily suspended during any acute illness, before major surgical procedures, and before iodinated contrast or oral phosphate sodium administration.

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The Effect of Oral Sodium Phosphate Drug Products on Renal Function in Adults Undergoing Bowel Endoscopy

et al. 2008

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Background: Oral sodium phosphate solution (OSPS) preparations are preferred cleansing agents for colonoscopy because of ease of use and excellent preparation quality. Besides causing acute renal failure in some patients, the high phosphorus content can potentially cause chronic kidney damage to patients undergoing colonoscopy. Methods: We carried out a retrospective study on patients with creatinine levels in the normal range who had undergone colonoscopy or flexible sigmoidoscopy using OSPS preparation from January 1998 to February 2005 and followed them for 1 year to determine its effects on their renal function. A control group of patients with similar comorbidities during this period were chosen to assess agerelated decline in renal function in this population. Results: A total of 286 patients were selected in the study group, and 125 patients were selected in the control group. Both groups had similar baseline characteristics. The base-line glomerular filtration rate (GFR) in the study group was 79 mL/min/1.73 m 2 , which declined to 73 mL/min/ 1.73 m 2 at 6 months after exposure to OSPS preparation. This finding was significantly different from the control group, in whom the baseline GFR was 76 mL/min/ 1.73 m 2 and remained stable at 6 months. Linear regression analysis showed that use of angiotensinconverting enzyme inhibitors and/or angiotensin receptor blockers and the presence of diabetes were significant determinants of the fall in GFR after use of OSPS preparation. Conclusions: Oral sodium phosphate solution preparation is associated with decline in GFR in elderly patients with creatinine levels in the normal range. Its routine use for elective and screening procedures should be discouraged in the elderly population.

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Renal failure following bowel cleansing with a sodium phosphate purgative

Cited by 14 publications

References 7 publications

Can ACE Inhibitors and Angiotensin Receptor Blockers Be Detrimental in CKD Patients?

Can ACE Inhibitors and Angiotensin Receptor Blockers Be Detrimental in CKD Patients?

Does concurrent renin‐angiotensin‐aldosterone blockade in (older) chronic kidney disease patients play a role in the acute renal failure epidemic in US hospitalized patients?—Three cases of severe acute renal failure encountered in a northwestern Wisconsin Nephrology practice

The Effect of Oral Sodium Phosphate Drug Products on Renal Function in Adults Undergoing Bowel Endoscopy

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