Constipation in Patients With Chronic Kidney Disease

Abstract

Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician’s perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.

Gut–Kidney–Heart: A Novel Trilogy

“…Oral administration in rats affected by CDK, for instance, decreased the plasma levels of microbiome-derived uremic toxins, attenuating tubulointerstitial damage and renal fibrosis by restoring the Lactobacillaceae and Prevotella families [2]. However, lubipristone is associated with diarrhea and nausea [172].…”

The causal relationship between Eubacterium and constipation: a Mendelian randomization study

“…Substantial current evidence suggests that the gut microbiome, bile secretion, lifestyle, and behavioral psychology are all factors in uencing constipation. (Cha et al 2023; Erhardt et al 2023;Neves et al 2023; Wang et al 2023). Central to intestinal well-being and digestion is the gut microbiome-a rich ecosystem of microorganisms such as bacteria, fungi, and viruses that inhabit the human gastrointestinal tract (Wu et al 2024).…”