Estimated GFR Decline Following Sodium Phosphate Enemas Versus Polyethylene Glycol for Screening Colonoscopy: A Retrospective Cohort Study

Nefropatía aguda por fosfatos secundaria al uso de laxantes con fosfato de sodio: caso clínico-patológico

“…Sin embargo, algunos estudios han descrito casos de NAP por el uso de enemas de FS con dosis desde 250 ml, con mayor riesgo en adultos mayores 18 . En otro estudio retrospectivo realizado en 70.499 participantes que se realizaron colonoscopía, el uso de enema de FS se asoció a un mayor riesgo de IRA dentro de los 15 meses posteriores a su uso 19 . Pese a lo anterior, los informes no son concluyentes entre la asociación de enemas de FS y NAP.…”

Consumption of phosphorus‐containing beverages as a potential aggravating cause of Mesoamerican nephropathy

“…8 The use of phosphate-containing enemas has been linked with an increased prevalence of decline in eGFR. 9 The pathology of phosphate nephropathy is either acute tubular necrosis or a chronic interstitial nephritis, the latter manifestation being not dissimilar to Mesoamerican nephropathy. 10 While the cause of Mesoamerican nephropathy may be multifactorial, the ingestion of large volumes of phosphorus containing liquids in a setting of dehydration and heat stress does not appear to be a good idea.…”

Phosphate enemas and GFR decline: it’s premature to sound the alarm

“…7,8 A retrospective cohort study published in American Journal of Kidney Disease challenges the belief that SPE use does not lead to kidney injury. 9 Schaefer et al 9 evaluated 70,499 Veteran Affairs patients who received SPEs with or without PEG (n ¼ 6407) versus PEG alone (n ¼ 64,092) prior to colonoscopy. Estimated glomerular filtration rate (eGFR) decline was defined as $50% increase in serum creatinine within 15 months postcolonoscopy.…”

“…First, 5690 of the 6407 (89%) patients in the SPE group also received PEG. 9 SPE alone is widely regarded as insufficient to cleanse the bowel prior to colonoscopy, although it may be a helpful adjunct, and overall 99% of the study population received PEG. Because the exposure was defined based on a prescription for SPE or PEG within 6 months prior to colonoscopy, it is unclear whether patients used SPE in preparation for screening colonoscopy, or at other times and for other indications such as constipation.…”

“…Inclusion of variables that do not impact exposure or outcome, or variables that are in the causal pathway between exposure and outcome, may influence the validity of the model results. In the multivariate model constructed by Schaefer et al, 9 for example, chronic obstructive pulmonary disease and asthma are not known to influence eGFR, whereas anemia is on the causal pathway between CKD and changes in eGFR.…”