ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: SA-PO524

Constipation and Risk of Death and Cardiovascular Events in Hemodialysis Patients

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Jung, Juyoung, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Park, Sang-Cheol, Artificial Intelligence and Robotics Laboratory, Myongji Hospital, Goyang, Korea (the Republic of)
  • Choi, Hye Min, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Oh, Dong-jin, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Kwon, Young Eun, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Baeg, Song in, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)
  • Yu, Hyokyeong, Myongji Hospital, Goyang, Gyeonggi-do, Korea (the Republic of)

Constipation is common in dialysis patients and primary care. Recent studies have disclosed its independent associations with the increased risk of mortality or cardiovascular disease in the general population. In this study, we aimed to investigate the association of constipation with clinical outcomes using a large cohort of hemodialysis (HD) patients in Korea.


This retrospective, population-based cohort study used HD quality assessment data from the Korean Health Insurance Review and Assessment (HIRA) during the period between January 2015 and June 2021. Public medical insurance registration is mandatory in Korea, and HIRA is an independent agency that reviews and assesses healthcare benefit costs.
Constipation was defined as the number of total prescribed laxatives of ≥ 180 during the baseline one year period. The primary endpoint was evaluated as the development of all-cause mortality and cardiovascular events including myocardial infarction (MI) and stroke. Each event was identified as the relevant International Classification of Disease (ICD)-10 diagnosis as the major diagnostic code and procedural codes for the health insurance claims.


A total of 35,230 patients over the age of 19 years old were included in the study, and the mean follow-up period was 54.2 month. Overall, 25.9% of HD patients were identified as having constipation, which seemed to be higher than the reported 15-20% in the general population. The most frequently used laxatives were lactulose/lactitol. In Cox proportional hazard model, constipation was associated with increased all-cause mortality (hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.09–1.23) and ischemic stroke (HR, 1.16; 95% CI, 1.0.–1.32) after multivariable adjustment for demographics, prevalent comorbidities, and medications. Constipation was not significantly associated with MI and hemorrhagic stroke after multivariable adjustments although the crude cumulative incidence of each was higher in patients with constipation.


Constipation was associated with higher risk of all-cause mortality and incident ischemic stroke independently of known cardiovascular risk factors in prevalent HD patients. Further studies are needed to determine whether constipation serve as one of the indicators of poor health or is a possible causal factor to cardiovascular disease.