Constipation in CKD

Abstract

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.

Associations between constipation symptoms and the sleep quality in non-dialysis chronic kidney disease patients: a cross-sectional study

“…It is in agreement with recent studies that have shown that both drug groups are associated with nocturia [35][36][37] and decreased gastrointestinal motility [19,[38][39][40]. Recent review articles comprehensively analyzed possible pathogenic mechanisms of CKD-related constipation [41,42].…”

An Innovative Synbiotic Formulation Decreases Free Serum Indoxyl Sulfate, Small Intestine Permeability and Ameliorates Gastrointestinal Symptoms in a Randomized Pilot Trial in Stage IIIb-IV CKD Patients

“…The CKD-associated dysbiosis is characterized by a prevalence of proteolytic species, with increased production and reduced clearance of uremic toxins, such as IS, PCS, TMAO and IAA [ 4 , 5 ]. Constipation and intestinal permeability are two other typical CKD-associated factors [ 16 ], respectively representing a risk for CKD progression [ 7 ] and triggering local and systemic inflammation [ 8 ]. The dynamics of the above-described gut-kidney axis led to the development of a field of research aiming to manipulate gut microbiota in order to reduce UTs production, alleviate inflammatory and oxidative outcomes, and delay CKD progression [ 12 , 15 ].…”

Coronavirus Disease 2019: Quick Diet and Nutrition Guide for Patients With Chronic Kidney Disease

“… 23 , 24 , 25 A high fiber plant-based diet should be recommended, given their favorable effect on the microbiome 17 and gut transit time that may improve constipation. 26 , 27 …”