Bowel health in chronic kidney disease: Patient perceptions differ from clinical definitions

Trimingham, Claire; McDonald, S.; Dansie, Kathryn; Jesudason, Shilpanjali; Faull, Randall J.; Clayton, Phil; Liew, Grace; Leu, Richard K. Le; Meade, Anthony

doi:10.1111/jorc.12230

Cited by 8 publications

(15 citation statements)

References 18 publications

(37 reference statements)

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“…We believe that the self-assessment of the severity of our patients' symptoms was influenced by the chronic maintenance of the intensity of the symptoms, that is, they became accustomed to feeling their symptoms so they cannot distinguish their severity unless a symptom is aggravated [ 42 ]. Age could be another factor of bias in the evaluation of symptoms, since although the questionnaire was carefully explained to each patient, some showed difficulty in evaluating the severity of their symptoms.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis

et al. 2018

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Gastrointestinal symptoms (GIS) are common in patients with end-stage renal disease (ESRD) and are associated with nutritional risks resulting from low food intake. Little is known about the relationship between GIS and malnutrition in geriatric patients with ESRD. The main objective of this study was to determine the relationship between nutritional status and severity of GIS in geriatric patients on dialysis therapy. Clinically-stable geriatric patients (older than 60 years old) who were dialysis outpatients were included in this cross-sectional study. The severity of GIS was assessed using the Gastrointestinal Symptoms Questionnaire (GSQ, short version), with patients classified into three groups: mild, moderate, and severe. Nutritional status was evaluated with the Malnutrition Inflammation Score (MIS), anthropometric assessment, biochemical parameters, and bioelectrical impedance. Descriptive statistics were used and differences between groups were analyzed with ANOVA and Kruskal Wallis, with a p < 0.05 considered to indicate significance. Fifty patients completed the study; the median age was 67 years old. Twenty-three patients were on hemodialysis (HD) and 27 were on peritoneal dialysis (PD). No significant differences were found according to dialysis modality, presence of diabetes, or gender. Ninety percent of patients had at least one GIS. Poorer nutritional status (evaluated by MIS) was related to a higher severity of GIS. There were no significant differences with other nutritional parameters. Our study showed a high prevalence of GIS in geriatric patients. There were no differences in observed GIS values that were attributed to dialysis modality, gender, or presence of type 2 diabetes mellitus (DM2). Severe GIS values were associated with poorer nutritional status determined by MIS, however, there was no association with anthropometry, biochemical values, or bioimpedance vector analysis.

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Section: Discussionmentioning

confidence: 99%

Relationship between Nutritional Status and Gastrointestinal Symptoms in Geriatric Patients with End-Stage Renal Disease on Dialysis

et al. 2018

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“…28 In fact, a recent cross-sectional study reported that more than half of patients with CKD (n ¼ 180) who had less frequent bowel movements (defined as bowel frequency of once every 4 to 6 days per week or less) with abnormal stool form and gastrointestinal symptom(s) perceived their bowel health as "normal" or "more normal than abnormal." 32 This finding clearly tells us that sole reliance on self-reporting of constipation in CKD may lead to the underestimation of the clinical problem, strongly suggesting the need for an active and standardized assessment of constipation in CKD by using subjective diagnostic tools such as the Rome criteria and the Bristol Stool Form Scale, which have yet rarely been used in clinical practice in the CKD population.…”

Section: Prevalence Of Constipation In Ckd Diagnostic Criteriamentioning

confidence: 99%

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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“…The burden of these GI symptoms in dialysis patients is poorly understood. Recent research suggests patients’ perceptions of their bowel health and clinical definitions of normal or abnormal bowel health are disconnected . The aim of this review is to summarize the current body of evidence describing the prevalence of GI symptoms reported in dialysis populations, as well as the assessment tools being used.…”

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confidence: 99%