Abstract: SA-PO899
Laxative Use in Patients with Advanced CKD Transitioning to Dialysis
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Sumida, Keiichi, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Dashputre, Ankur A., University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Kar, Suryatapa, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Obi, Yoshitsugu, University of California Irvine, Irvine, California, United States
- Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States
- Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States
- Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
- Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
Background
Constipation, typically managed by laxatives, is one of the most prevalent conditions in primary care settings and associated with poor quality of life and adverse outcomes. Constipation is highly prevalent in dialysis patients; however, little is known about laxative use in patients with advanced CKD transitioning to dialysis.
Methods
In 67,377 US veterans transitioning to dialysis from 10/2007-3/2014, we examined the proportion of patients who filled a prescription for any type of laxatives within each 6-month time period over 36 months pre- and post-transition to ESRD. Prescribed laxatives were ascertained using both inpatient and outpatient prescriptions sourced from CMS Medicare Part D and VA pharmacy dispensation records. We also identified factors associated with pre-ESRD laxative use by multivariable logistic regression.
Results
The proportion of patients prescribed laxatives was 14% in -36 to <-30 months pre-transition to ESRD and gradually increased as patients progressed to ESRD. Laxative use markedly increased immediately prior to ESRD transition and reached the highest proportion (28%) in the first 6 months post-transition. The proportion remained relatively stable at ~23% throughout the rest of the post-transition period (Figure). The use of antihistamines (OR [95%CI], 3.12 [2.89-3.37]), antacids (2.06 [1.96-2.17]), and K-lowering agents (1.73 [1.65-1.82]) were the strongest factors associated with pre-ESRD laxative use after multivariable adjustment.
Conclusion
Laxative use increased considerably and peaked at 28% as patients neared transition to ESRD and remained fairly stable thereafter, likely mirroring the increasing burden of drug-induced constipation during the transition period. Further studies are needed to elucidate the underlying causes of this trend and the clinical implication of constipation management in advanced stages of CKD.
Funding
- NIDDK Support