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Kidney Week

Abstract: SA-PO653

Constipation and Clinical Outcomes in Peritoneal Dialysis: Results from Thailand PDOPPS

Session Information

  • Home Dialysis - II
    November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Kanjanabuch, Talerngsak, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand
  • Halue, Guttiga, Phayao Hospital, Phayao, Phayao, Thailand
  • Tharapanich, Huttaporn, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand
  • Phannajit, Jeerath, Chulalongkorn University Faculty of Medicine, Bangkok, Bangkok, Thailand
  • Johnson, David W., Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  • Perl, Jeffrey, St Michael's Hospital, Toronto, Ontario, Canada
  • Pecoits-Filho, Roberto, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
Background

Patient-reported outcome measures (PROM) has gained international recognition as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand the associations between patient-reported constipation and clinical outcomes.

Methods

Constipation was determined in patients across 22 facilities in Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) during 2014-2017. Constipation was diagnosed using both objective assessment tools (Bristol Stool Form Scale [BSFS]) and self-reported questionnaire, constipation severity score [CSS]). BSFS is a 7-level scale visual inspection of feces (from 1 to 7, from hard to softer) based on its texture and morphology. Whilst the CSS measures duration (1 item) and severity (7 items: frequency of bowel movement, difficulty, pain, completeness, attempt duration, defecation assistance, frequency of attempt failure) of constipation and is a self-filled questionnaire, with participants being asked to respond on a 5-point Likert scale coded. Cox proportional hazards model regression was used to estimate associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis.

Results

634 of 975 randomly selected PD patients from 22 facilities reported their constipation by using BSFS and CSS. In this questionnaire, the patients rated their constipation as well as a change in constipation over time. Constipation was common in the PD population, particularly in patients with older age, marriage, diabetes, lower educational level, and worse nutritional status (including lower time-average serum albumin and phosphate concentrations). Interestingly, self-reported constipation at baseline was significantly associated with shorter time to first and higher rates of peritonitis (hazard ratio [HR] 1.74, 95%CI 1.29-2.34) and death (HR 2.43, 95%CI 1.82-3.24) but not HD transfer (HR 1.25, 95%CI 0.7-2.21) after adjusting for age, gender, PD vintage, comorbidities, shared frailty by study sites, and serum albumin.

Conclusion

Patient-reported constipation was independently associated with higher risks of peritonitis and all-cause mortality, but not HD transfer. This warrants further investigation to identify effective interventions.