Keiichi Sumida1, Ankur A Dashputre1,2, Praveen K Potukuchi1,2, Fridtjof Thomas3, Yoshitsugu Obi1, Miklos Z Molnar1,4,5,6, Justin D Gatwood7, Elani Streja8, Kamyar Kalantar-Zadeh8, Csaba P Kovesdy1,9. 1. Department of Medicine, Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 2. College of Graduate Health Sciences, Institute for Health Outcomes and Policy, University of Tennessee Health Science Center, Memphis, TN, USA. 3. Department of Preventive Medicine, Division of Biostatistics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 4. James D. Eason Transplant Institute, Methodist University Hospital, Memphis, TN, USA. 5. Department of Surgery, Division of Transplant, University of Tennessee Health Science Center, Memphis, TN, USA. 6. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary. 7. Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Nashville, TN, USA. 8. Division of Nephrology and Hypertension, Harold Simmons Center for Chronic Disease Research and Epidemiology, University of California-Irvine, Orange, CA, USA. 9. Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA.
Abstract
BACKGROUND: Constipation is highly prevalent in patients with chronic kidney disease (CKD), particularly among those with end-stage renal disease (ESRD), partly due to their dietary restrictions, comorbidities and medications. Laxatives are typically used for constipation management; however, little is known about laxative use and its associated factors in patients with advanced CKD transitioning to ESRD. METHODS: In a retrospective cohort of 102 477 US veterans transitioning to dialysis between October 2007 and March 2015, we examined the proportion of patients who filled a prescription for any type of laxative within each 6-month period over 36 months pre- and post-transition to ESRD. Factors associated with laxative use during the last 1-year pre-ESRD period were identified by multivariable logistic regression. RESULTS: The proportion of patients prescribed laxatives increased as patients progressed to ESRD, peaking at 37.1% in the 6 months immediately following ESRD transition, then remaining fairly stable throughout the post-ESRD transition period. Among laxative users, stool softeners were the most commonly prescribed (∼30%), followed by hyperosmotics (∼20%), stimulants (∼10%), bulk formers (∼3%), chloride channel activator (<1%) and several combinations of these. The use of anticoagulants, oral iron supplements, non-opioid analgesics, antihistamines and opioid analgesics were among the factors independently associated with pre-ESRD laxative use. CONCLUSION: The use of laxatives increased considerably as patients neared transition to ESRD, likely mirroring the increasing burden of drug-induced constipation during the ESRD transition period. Findings may provide novel insight into better management strategies to alleviate constipation symptoms and reduce medication requirements in patients with advanced CKD. Published by Oxford University Press on behalf of ERA-EDTA 2020. This work is written by US Government employees and is in the public domain in the US.
BACKGROUND: Constipation is highly prevalent in patients with chronic kidney disease (CKD), particularly among those with end-stage renal disease (ESRD), partly due to their dietary restrictions, comorbidities and medications. Laxatives are typically used for constipation management; however, little is known about laxative use and its associated factors in patients with advanced CKD transitioning to ESRD. METHODS: In a retrospective cohort of 102 477 US veterans transitioning to dialysis between October 2007 and March 2015, we examined the proportion of patients who filled a prescription for any type of laxative within each 6-month period over 36 months pre- and post-transition to ESRD. Factors associated with laxative use during the last 1-year pre-ESRD period were identified by multivariable logistic regression. RESULTS: The proportion of patients prescribed laxatives increased as patients progressed to ESRD, peaking at 37.1% in the 6 months immediately following ESRD transition, then remaining fairly stable throughout the post-ESRD transition period. Among laxative users, stool softeners were the most commonly prescribed (∼30%), followed by hyperosmotics (∼20%), stimulants (∼10%), bulk formers (∼3%), chloride channel activator (<1%) and several combinations of these. The use of anticoagulants, oral iron supplements, non-opioid analgesics, antihistamines and opioid analgesics were among the factors independently associated with pre-ESRD laxative use. CONCLUSION: The use of laxatives increased considerably as patients neared transition to ESRD, likely mirroring the increasing burden of drug-induced constipation during the ESRD transition period. Findings may provide novel insight into better management strategies to alleviate constipation symptoms and reduce medication requirements in patients with advanced CKD. Published by Oxford University Press on behalf of ERA-EDTA 2020. This work is written by US Government employees and is in the public domain in the US.
Authors: Csaba P Kovesdy; Ahmed Alrifai; Elvira O Gosmanova; Jun Ling Lu; Robert B Canada; Barry M Wall; Adriana M Hung; Miklos Z Molnar; Kamyar Kalantar-Zadeh Journal: Clin J Am Soc Nephrol Date: 2016-04-21 Impact factor: 8.237
Authors: Ali Ramezani; Ziad A Massy; Björn Meijers; Pieter Evenepoel; Raymond Vanholder; Dominic S Raj Journal: Am J Kidney Dis Date: 2015-11-15 Impact factor: 8.860