Renal risk associated with sodium phosphate medication: safe in healthy individuals, potentially dangerous in others

Abstract

Because of safety concerns, sodium phosphate purgatives are not recommended for routine bowel cleansing. Despite some serious and even fatal adverse events associated with these drugs when used with at-risk patients, available data suggest that administration of sodium phosphate purgatives is relatively safe in nonrisk individuals(i.e., in adequately hydrated, otherwise healthy adults, younger than 55 years with evidence of normal renal function).

Multicenter feasibility study of bowel preparation with castor oil for colon capsule endoscopy

“…If the data of all listed studies above are taken together, the capsule excretion rate would be 88% (1243/1407). Recently, the use of sodium phosphate has been limited as a result of acute phosphate nephropathy and electrolyte disturbances . To avoid these adverse events, other preparation methods with PEG plus ascorbic acid‐based, magnesium‐based, sulfate‐based, and gastrografin‐based (water‐soluble iodinated radiopaque oral contrast medium) boosters have been tried.…”

“…Recently, the use of sodium phosphate has been limited as a result of acute phosphate nephropathy and electrolyte disturbances. [22][23][24] To avoid these adverse events, other preparation methods with PEG plus ascorbic acid-based, magnesium-based, sulfate-based, and gastrografin-based (water-soluble iodinated radiopaque oral contrast medium) boosters have been tried. However, PEG plus ascorbic acid only did not elevate the total colonoscopy rate, 76% (37/49), 25 nor did PEG followed by magnesium citrate booster, 71% (22/31 in total 3.9 L regimen) and 55% (16/29 in total 4.5 L).…”

Novel Insights into Crystal-Induced Kidney Injury

“…Vitamin C supplements or accidental polyethylene glycol ingestion trigger acute oxalate nephropathy because oxalate is their major downstream water-soluble metabolite [19, 20]. Sodium phosphate, a component of oral bowel purgatives often used before colonoscopy, can cause massive intratubular precipitation of calcium phosphate crystals, leading to acute phosphate nephropathy [21]. Finally, sulfameth­oxazole, indinavir, aciclovir, and other drugs can cause acute crystalline kidney injury, especially when high doses coincide with low fluid intake [22].…”

Comparing reduced-dose sodium phosphate tablets to 2 L of polyethylene glycol: A randomized study

“…NaP is associated with the potential risk of electrolyte and renal impairment[11,12]. The age limits for this preparation have not been defined; however, one study suggested that NaP should be used for patients younger than 55 years of age who have a normal renal function[13]. In addition, our subgroup analysis indicated that the use of NaP by elderly patients had little merit.…”