Kidney Week

Abstract: SA-PO882

Association of Laxative Use with Change in eGFR in Patients with Advanced CKD

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

Keiichi Sumida,

• Potukuchi, Praveen Kumar, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Praveen Kumar Potukuchi,

• Dashputre, Ankur A., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Ankur A. Dashputre,

• Kar, Suryatapa, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Suryatapa Kar,

• Thomas, Fridtjof, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Fridtjof Thomas,

• Obi, Yoshitsugu, University of California Irvine, Irvine, California, United States

Yoshitsugu Obi,

• Molnar, Miklos Zsolt, University of Tennessee Health Science Center, Memphis, Tennessee, United States

Miklos Zsolt Molnar,

• Streja, Elani, Harold Simmons Center for Kidney Disease Research and Epidemiology, Orange, California, United States

Elani Streja,

• Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States

Kamyar Kalantar-Zadeh,

• Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States

Csaba P. Kovesdy,

Background

Constipation is highly prevalent in advanced CKD and is associated with adverse kidney outcomes potentially through altered gut microbiota. Laxatives are typically used for constipation management; however, little is known about the effect of laxatives on kidney function in advanced CKD patients.

Methods

We examined the association of laxative use with change in eGFR (slope) over the last two years before dialysis initiation in 25,140 US veterans transitioning to dialysis from 2007-2014. Laxative use was defined as having ≥2 prescriptions of laxatives of ≥30-day supply each during the two-year prelude period. eGFR slopes were estimated by linear mixed effects models using all available outpatient eGFR measurements in the same period. Associations were examined in multinomial logistic regression models with adjustment for demographics, comorbidities, medications, nephrology care, cumulative length of hospital stay, vascular access type, and clinical variables.

Results

The mean (SD) age of the cohort was 70 (11) years; 98% were male; 26% were African American; and 75% were diabetic. Patients with (vs. without) pre-ESRD laxative use were at lower risk of experiencing more progressive eGFR decline and also had higher risk of increasing eGFR even after accounting for various potential confounders (fully adjusted multinomial odds ratios [95% CI] for eGFR slope <-10, -10-<-5, and ≥0, vs. -5-<0 mL/min/1.73 m²/year, 0.86 [0.78-0.94], 0.59 [0.54-0.65], and 1.26 [1.03-1.52], respectively; Figure).

Conclusion

The use of laxatives may have potential renoprotective benefits in advanced CKD patients, in whom the gut gains importance in the acid-base and mineral homeostasis and the disposal of nitrogenous waste products. Further studies are needed to elucidate the underlying mechanisms and to evaluate its clinical effectiveness.

Funding

• NIDDK Support