Colonoscopy preparation-induced disorders in renal function and electrolytes

Florentin, Matilda; Liamis, Georgé; Elisaf, Moses

doi:10.4292/wjgpt.v5.i2.50

Cited by 13 publications

(17 citation statements)

References 33 publications

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“…Bowel preparation was the same for all the patients, and none of them received oral sodium phosphate, which has been associated with AKI 12 . On the other hand, a large outpatient screening study showed that AKI risk is not associated with oral sodium phosphate.…”

Section: Discussionmentioning

confidence: 99%

“…Sedation during colonoscopy may lead to hypoxemia, bradycardia, hypotension, cardiac arrhythmias, or cerebrovascular events 10 , 11 . Complications specifically related to bowel preparation include poor preparation, kidney injury and hydro-electrolyte disorders 12 - 14 . Sodium phosphate solutions for bowel preparation have been related to increased risk of acute renal failure (acute phosphate nephropathy possibly associated with hyperphosphatemia) and delayed kidney injury 12 .…”

Section: Introductionmentioning

confidence: 99%

“…Complications specifically related to bowel preparation include poor preparation, kidney injury and hydro-electrolyte disorders 12 - 14 . Sodium phosphate solutions for bowel preparation have been related to increased risk of acute renal failure (acute phosphate nephropathy possibly associated with hyperphosphatemia) and delayed kidney injury 12 . Some retrospective studies have found similar rates of kidney injury after colonoscopy with sodium phosphate solutions or polyethylene glycol-based solutions.…”

Section: Introductionmentioning

confidence: 99%

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Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital

Ivanovic

Silva

Lichtenstein

et al. 2018

Clinics

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OBJECTIVES:To describe clinical complications related to colonoscopy in inpatients with multiple diseases. Among the known complications, acute kidney injury was the primary focus.METHODS:This was an observational retrospective study of 97 inpatients. Data relating to age; gender; comorbidities; current medication; blood tests (renal function, blood glucose and LDL cholesterol levels); length of hospital stay; indication, results, and complications of colonoscopies; and time to the development of kidney injury were collected between June 2011 to February 2012.RESULTS:A total of 108 colonoscopies (9 screening and 88 diagnostic) were conducted in 97 patients. Renal injury occurred in 41.2% of the patients. The univariate analysis revealed that kidney injury was related to the use of diuretics, statins, calcium channel blockers, and angiotensin converting enzyme inhibitor; however, the multivariate analysis showed that only the use of diuretics was associated with kidney injury. The occurrence of kidney injury and the time to its development were independent of the previous glomerular filtration rate as calculated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.CONCLUSIONS:The use of diuretics was the only independent variable associated with the development of kidney injury in inpatients with multiple comorbidities who underwent colonoscopy. The occurrence of kidney injury and the time to its development were independent of previous CKD-EPI-based assessments of renal function. These results highlight the increased risk of colonoscopy in such patients, and its indication should be balanced strictly and perhaps avoided as a screening test.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital

Ivanovic

Silva

Lichtenstein

et al. 2018

Clinics

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“…With respect to other electrolytes, a number of abnormalities have been associated with OPS, including significant hypokalemia and hypernatremia 20 21 . These occur principally as a result of absorption of sodium present in the OPS through the intestinal epithelium in exchange for potassium when fluid intake is insufficient and intraluminal sodium concentration exceeds normal plasma levels 20 . Hypokalemia and hypernatremia are particularly frequent in the elderly 22 and, if severe, may be associated with cardiac rhythm disturbances.…”

Section: Methodsmentioning

confidence: 99%

A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity

Moulin

Ponchon

2018

Endosc Int Open

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Background and study aims Colonoscopy is a widely used diagnostic procedure which requires prior cleansing of the bowel. Many different bowel cleansing preparations have been developed, all of which have specific advantages and disadvantages. This review compares two low-volume high-osmolarity bowel cleansing preparations, oral phosphate salts and oral sulphate salts, with a particular focus on risk of nephrotoxicity. Patients and methods An electronic search of the Medline database was performed using the search terms “(phosphates OR sulfates) AND cathartics [MeSH Term] AND kidney” restricted to humans with a cut-off date of December 31, 2016. Results Introduction of oral phosphate salts offered the advantage of low intake volume and low risk of bowel irritation compared to previous options. However, phosphate salts have been associated with renal toxicity (acute phosphate nephropathy [APN]), thought to arise due to perturbations of calcium and phosphate homeostasis as a consequence of increases in serum phosphate. This results in high concentrations of calcium phosphate in the distal tubule and collecting ducts of the kidney, where it may precipitate. Although APN is rare, it may lead to permanent kidney damage. For this reason, phosphate salts are contraindicated in vulnerable patient groups. As an alternative to phosphate salts, oral sulphate salts have recently been introduced. Because sulphate absorption from the intestinal tract is saturable, serum sulphate concentrations increase only minimally after ingestion. Furthermore, excretion of sulphate in the kidney is not accompanied by calcium excretion and urine calcium levels are unchanged. For these theoretical reasons, use of sulphate salts as bowel cleansing solutions is not expected to lead to calcium precipitation in the nephron. Conclusions Oral phosphate salts are no longer recommended for routine use as bowel cleansing preparations as they carry significant risk of kidney damage and a safer alternative is available in the form of oral sulphate solutions. To date, use of sulphate salts has not been associated with elevations in serum creatinine or other markers of renal impairment, nor with clinical manifestations of kidney injury. Nonetheless, experience with sulphate salts in everyday practice is limited and physicians should be vigilant in detecting potential safety issues.

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“…Acute phosphate nephropathy can occur even in patients with normal renal function and also in patients with preexisting renal disease, especially those who are using diuretics or angiotensin converting enzyme inhibitors. Therefore, this preparation should be avoided in these patients [ 36 , 40 ]. The FDA in the United States has issued a black box warning pertaining to the risk of acute phosphate nephropathy associated with NaP in elderly and patients with preexisting renal disease.…”

Section: Introductionmentioning

confidence: 99%

Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization

Bechtold

Mir

Puli

et al. 2016

aog

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Colonoscopy is an important screening and therapeutic modality for colorectal cancer. Unlike other screening tests, colonoscopy is dependent on pre-procedure bowel preparation. If the bowel preparation is poor, significant pathology may be missed. Many factors are known to improve bowel preparation. This review will highlight those factors that may optimize the bowel preparation, including choice of bowel preparation, grading or scoring of the bowel preparation, special factors that influence preparation, and diet prior to colonoscopy that affects bowel preparation. The aim of the review is to offer suggestions and guide endoscopists on how to optimize the bowel preparation for the patients undergoing colonoscopy.

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Colonoscopy preparation-induced disorders in renal function and electrolytes

Cited by 13 publications

References 33 publications

Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital

Kidney injury and other complications related to colonoscopy in inpatients at a tertiary teaching hospital

A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity

Optimizing bowel preparation for colonoscopy: a guide to enhance quality of visualization

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