Constipation will affect the progress of chronic kidney disease

Constipation is a gastrointestinal dysfunctional disease that is not uncommon in the population, especially for women and the elderly. Recent observational studies suggest that constipation can cause chronic inflammatory status and increase the risk of cardiovascular disease by altering intestinal flora. Constipation is often associated with changes in intestinal flora, diabetes, non-steroidal anti-inflammatory drugs, lack of physical activity, and the like. And these factors are also closely related to the occurrence and progression of chronic kidney disease (CKD).

   So, whether constipation also affects the occurrence and progression of chronic kidney disease (CKD) through intestinal flora Is the status and severity of constipation closely related to the occurrence and progression of CKD? Keiichi Sumida from the University of Tennessee in the United States and other aspects of the relationship between constipation and CKD were discussed, the results published in the recent J Am Soc Nephrol magazine.

   In the US veteran research cohort, a total of 3,504,732 eGFR ≥ 60 mL / min / 1.73 m2 (initially without chronic kidney disease) was used to determine the constipation using the Cox model and the multivariate log regression model to diagnose the use of codes and laxatives Status and severity (no, mild, moderate to severe), to explore the relationship between constipation and the incidence of CKD, the incidence of end stage renal disease (ESRD) and eGFR changes.

   Where constipation is defined as at least two 60-day constipation diagnoses (determined by ICD9 coding), or twice or more from the veteran drug release record for 60 to 365 days, each lasting 30 days Licenses record. The severity of the constipation is determined by the type of laxative use: no laxative, mild constipation (using a laxative), moderate to severe (using two or more).

   Chronic nephropathy was defined as two eGFR <60 mL / min and 25% lower than baseline Egfr. ESRD was defined as a registry of USRDS registered by the American Kidney Disease System, starting at the start of the cohort until September 13, 2011, for continued dialysis or kidney transplantation. The eGFR change (slope) is calculated using the least squares method, using all outpatient eGFR calculations at the beginning of the queue until September 13, 2011 and divided into the following five categories: <-10, -10 ~ -5, -5 ~ -1, -1 to 0 (reference group), and> 0 mL / min / year.

   Corrected age, sex, baseline eGFR, comorbidities, etc., compared with patients without constipation, constipation patients are more prone to chronic kidney disease, more prone to ESRD and faster eGFR decline. The severity of constipation increases with the risk of the above outcome.

   Thus, constipation and its severity, independent of other known risk factors, are positively associated with the risk of chronic kidney disease and end-stage renal disease and the decline in eGFR. Future studies should focus on their underlying mechanisms and reduce constipation in reducing the incidence of adverse kidney outcomes.