Higher Frequency of Fruit Intake Is Associated With a Lower Risk of Constipation in Hemodialysis Patients: A Multicenter Study

Fiber intake and health in people with chronic kidney disease

“…The fiber supplements used in the interventions in the RCTs were: 11, cereals, cookies and snack bars with 23 g/day of added fiber for 4 weeks [ 53 ]; 12, muffins containing pea hull 10 g/day for the first 4 weeks, then pea hull 10 g/day + inulin 15 g/day for 6 weeks [ 42 ]; 14, one symbiotic gel [a mix of probiotics ( Lactobacillus acidophilus and Bifidobacterium lactis Bi-07); 2.31 g of a prebiotic fiber (inulin); 1.5 g of omega-3 fatty acids and vitamins] per day in fasting for 2 months [ 54 ]; 18, about 20 g fructooligosaccharides (FOS) daily for 30 days [ 55 ]; 19, about 10 g/day Inulin-type fructan (ITF) for 12 weeks (12 weeks washout) [ 10 ]; 20, high-fiber diet (12 g fiber per day) for 4 weeks [ 56 ]; 21, resistant starch (9 g/day for the first week, 18 g/day for following weeks) [ 22 ]. References: 1, PREDIMED study [ 57 ]; 2, Fujii study [ 58 ]; 3, Carvalho study [ 59 ]; 4, Gopinath study [ 60 ], 5, Mirmiran study [ 61 ]; 6, ULSAM cohort study [ 62 ]; 7, Chiavaroli study [ 20 ]; 8, Wu study [ 21 ]; 9, Kelly study [ 63 ]; 10, ULSAM cohort study (eGFR <60 mL/min/1.73 m 2 ) [ 64 ]; 11, Salmean study 2013 [ 53 ]; 12, Salmean study 2015 [ 42 ]; 13, Dos Santos study [ 65 ]; 14, Viramontes-Hörner study [ 54 ]; 15, Lin study [ 66 ]; 16, Wang study [ 15 ]; 17, Xu study [ 14 ]; 18, Meksawan study [ 55 ]; 19, Li study [ 10 ]; 20, Sutton study [ 56 ]; 21, Sirich study [ 22 ]; 22, Biruete [ 67 ]; and 23, Yang [ 23 ].…”

“…We speculate that because CAPD patients often preserve their residual kidney function, this may allow for higher intake of plant foods for some individuals. Despite diversity in study designs and patient characteristics, fiber supplementation studies consistently report lower incidence of constipation and alleviation from constipation among patients on HD [ 65 , 62 ], PD [ 54 , 56 ] and nondialysis CKD than in patients not receiving supplementation [ 53 , 69 ].…”

Gastrointestinal symptom burden and dietary intake in patients with chronic kidney disease

“…Describing GI symptoms without considering dietary intake limits interpretation and overlooks potential causes (Zuvela et al, 2018). Recent studies (Dos Santos et al, 2020; Saglimbene et al, 2019) have repeatedly shown low fruit and vegetable intakes in people with CKD, and Picard et al (2020) showed dietary information in Canada disproportionately targeted fruits and vegetables to reduce potassium intakes. Meanwhile there has been renewed interest and increasing evidence that there is a role for plant based eating for people with CKD (Carrero et al, 2020; Joshi et al, 2020; Kalantar‐Zadeh et al, 2020) which would have potential positive effects on GI function and symptoms.…”

A Mini Review of Plant-Based Diets in Hemodialysis

“…US Veterans using one or >2 types of laxatives experienced a similarly higher risk of all-cause mortality and cardiovascular and cerebrovascular burden when compared to US veterans not taking any laxatives. A recent multicenter study (n = 305) evaluated the prevalence and correlates of constipation in hemodialysis patients from 4 dialysis centers using a questionnaire based on the Roma IV criteria to assess constipation status and lifestyle habits along with a food frequency ques- tionnaire focused on the main sources of dietary fiber and found that >30% of patients had constipation at a given point in time [20]. In this study, the independent predictors of constipation symptoms included diabetes and lower frequency of fruit intake [20].…”

“…A recent multicenter study (n = 305) evaluated the prevalence and correlates of constipation in hemodialysis patients from 4 dialysis centers using a questionnaire based on the Roma IV criteria to assess constipation status and lifestyle habits along with a food frequency ques- tionnaire focused on the main sources of dietary fiber and found that >30% of patients had constipation at a given point in time [20]. In this study, the independent predictors of constipation symptoms included diabetes and lower frequency of fruit intake [20]. Moreover, constipation can worsen hyperkalemia, while having soft bowel movement may be associated with a lower likelihood of hyperkalemia [21].…”