Yasuda, G. et al. Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients. Am. J. Kidney Dis. 39, 1292-1299

Division of Nephrology, Second Department of Internal Medicine and Hygiene, Yokohama City University School of Medicine, Yokohama, Japan.
American Journal of Kidney Diseases (Impact Factor: 5.9). 06/2002; 39(6):1292-9. DOI: 10.1053/ajkd.2002.33407
Source: PubMed


Many hemodialysis patients suffer from constipation. The frequency of constipation has not been rigorously evaluated in continuous ambulatory peritoneal dialysis (CAPD) patients, however. We conducted a survey on constipation in CAPD patients and compared the findings with those in hemodialysis patients through a questionnaire. Daily dietary fiber and potassium intake were calculated from the patients' dietary records. In the questionnaire, patients were asked about bowel frequency, stool consistency, straining, and use of laxatives and resins. The frequency of constipation was 28.9% in 204 CAPD patients and 63.1% in 268 hemodialysis patients. The hemodialysis patients had a 3.14 times higher relative risk of constipation than the CAPD patients. Only 3.4% of CAPD patients needed resin to avoid hyperkalemia. Of hemodialysis patients, 49% needed resin. Among the 261 hemodialysis patients, 205 (78.5%) suppressed an urge to defecate during hemodialysis therapy. Potassium and total dietary fiber intake per day were 1.8 +/- 0.5 g and 11.0 +/- 4.0 g in CAPD patients, which were higher (P < 0.01) than the values in hemodialysis patients--1.3 +/- 0.5 g and 5.9 +/- 2.7 g. The results suggest that constipation occurs less frequently in CAPD patients than in hemodialysis patients. The low rate of constipating drug administration, dialysis modality-based lifestyle, and higher total dietary fiber intake may cause the lower prevalence of constipation in CAPD patients.

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    • "constipation before using the pregabalin, which is a common complication faced by most of the ESRD patients that are on HD (Singharetnam & Holley, 1996; Wu et al., 2004; Yasuda et al., 2002). Most of HD patients are on oral iron supplementation. "
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    ABSTRACT: Objectives: The aim of this study was to assess the safety and probability of adverse events associated with the use of 75 mg pregabalin post hemodialysis (pHD) among patients with UP. Methods: A cross-sectional study done among the hemodialysis patients suffering from uremic pruritus (UP) Aljaber Kidney Center (AJKC), Al-Ahsa, Eastern Province, Saudi Arabia. Assessment for the safety profile of pregabalin was done using Naranjo's algorithm. A predictive model was developed using binary multiple logistic regression to explore association of patients' demographics and risk factors with the occurrence of AEs. Throughout statistical significance level was considered significant at 0.05. Key findings: Assessment of safety of pregabalin revealed that somnolence and dizziness were the two frequent adverse events followed by constipation, weight gain and edema. However, it was noticed that female patients aged less than 50 years were found to be at a higher risk in comparison with men. Moreover, those patients having one comorbid complication (i.e. hypertension or diabetes mellitus alone) were at a higher risk of somnolence, weight gain and dry mouth. Conclusion: Naranjo's quantification for the possibility and probability of adverse events reflect that all the events were probable. Age, gender and comorbid medical conditions are some of the factors that might have clinical association with the occurrence of the AEs.
    Full-text · Article · Jan 2015 · Saudi Pharmaceutical Journal
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    • "The numbers of anaerobic bacteria, including Bifidobacterium, Lactobacillus and Prevotella, are decreased, and the numbers of Clostridium perfringens, aerobic enterococci and enterobacteria are increased in HD patients compared with healthy subjects [10]. The primary reasons for these changes include chronic constipation, increased colonic transit times, decreased consumption of dietary fiber and impaired protein assimilation in the small intestine secondary to the uremic milieu that is present in the colon in HD patients [11] [12] [13] [14]. As a consequence of these changes, the composition of the colonic microbiota is altered, and the absorption of potentially toxic protein fermentation metabolites, such as phenols, indols, thiols, amines and oxalic acid, is increased in these patients. "
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    ABSTRACT: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in chronic kidney disease (CKD) patients receiving hemodialysis (HD). Oxalic acid is a uremic retention molecule that has been extensively studied in the pathogenesis of calcium-oxalate stones. Oxalobacter formigenes (O. formigenes), a component of the colonic microbiota, plays an important role in oxalate homeostasis. Little is known regarding the colonization of HD patients by O. formigenes and the exact role of this bacterial species in oxalic acid metabolism in these patients. We hypothesized that oxalic acid may be insufficiently degraded in HD patients due to under colonization of the colon by O. formigenes in these patients. To test this hypothesis, we sought to quantitatively measure fecal O. formigenes levels and serum oxalic acid levels in HD patients. We also suggest that increased oxalic acid levels may be associated with endothelial dysfunction and aortic stiffness, both of which are commonly observed in HD patients. Increased colonization with O. formigenes via the ingestion of prebiotics and probiotics could potentially decrease serum oxalic acid levels and improve cardiovascular outcomes in HD patients. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Jan 2015 · Medical Hypotheses
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    • "There are many reasons to explain the greater prevalence of these symptoms in uremia, e.g. uremia itself, the effect of treatment, the dietary and lifestyle changes, a history of corticosteroid therapy, medications and residual renal function [19] [20]. However, the consequences of GI symptoms have as yet not been well defined. "
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    ABSTRACT: Peritonitis is still one of the major causes of peritoneal dialysis (PD) patients' dropout. In the present study, we analyzed the relationship between gastrointestinal (GI) problems and peritonitis in our CAPD patients. It is a prospective observational study. In December, 2008, 158 patients on continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months from our PD unit were included in this study. A questionnaire was used to evaluate their GI symptoms score (GISS). All patients were followed up for 24 months or until they dropped out from our PD program. All peritonitis events were recorded. The patients' PD duration was 22 (4 - 132) months before the study. During the 24 months follow-up, 37 patients dropped out. And 37 patients had 46 episodes of peritonitis (peritonitis group) whereas the other 121 patients did not have peritonitis (peritonitisfree group). The overall peritonitis rate was one episode per 75.87 patient months. The peritonitis free group had lower GISS (1.35 ± 1.94 vs. 2.95 ± 3.19, p = 0.006), higher albumin level and longer dialysis duration at baseline as compared to the peritonitis group. Multivariate Cox-regression analysis showed that only GISS (OR 1.206, 95% CI 1.093 - 1.330) and dialysis duration (OR 1.018, 95% CI 1.006 - 1.031) were the risk factors for the time to first peritonitis episodes during the follow-up. Further analysis identified 2 GISS components, belching and constipation, as the strongest predictors of peritonitis during the follow-up period (p < 0.005). Our study showed that GI symptoms could predict peritonitis in CAPD patients. Prevention and treatment for GI problems may thus be helpful to decrease peritonitis rate.
    Full-text · Article · Apr 2012 · Clinical nephrology
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