MO515
CONSTIPATION IN CHRONIC KIDNEY DISEASE: PREVALENCE AND RISK FACTORS

Abstract

Background and Aims

Among various gastrointestinal disorders, constipation is one of the most common symptom in chronic kidney disease (CKD). However it is often neglected by nephrologists as self-limiting condition. Constipation impacts quality of life in multiple ways and increases socio-psychological burden. Constipation and associated risk factors have been poorly studied and most studies are retrospective.

Method

We enrolled CKD stage 3 to 5 patients on regular follow-up with nephrologist from June 2018 to June 2020, at a tertiary care centre in North India. Constipation was defined using Rome IV criteria (Functional constipation) which is composed of six constipation related symptoms, and diagnosis of constipation is established by presence of two or more symptoms for at least 3 months. Patients were also asked to maintain a 7 day prospective stool diary. It consisted of seven day written prospective chart of stool form and frequency. Patients were instructed to record when each bowel movement happened and to mark stool form type for each movement as described in words and pictures on Bristol Stool Form Scale (BSFS). Opioid induced constipation was defined as per Rome IV criteria. The diagnostic criteria is similar to functional constipation, but with requisite that new or worsening symptoms occurred when initiating, changing or increasing opioid therapy.

Results

Two hundred twenty five patients were studied out of which 59 (26.2%) patients were in CKD stage3, eighty one (36%) patients were in CKD stage4 and 85 (37.8%) patients were in stage5. Out of 85 CKD stage5 patients, 23 (27%) were on dialysis. Mean age of patients was 49.1 years. Out of 225 patients, 135 (60%) were male. Constipation symptoms and diagnosis reported in each stage has been depicted in Table 1. Clinical correlates of constipation has been depicted in Table 2.

MO515 Table 2:

Clinical profile and its correlation with constipation in CKD Stage3-5

Clinical profile	CKD Stage 3	CKD Stage 4	CKD Stage 5	p value
Diabetes	28	23	36	<0.001
Hypertension	41	56	79	<0.001
Cardiovascular disease	08	06	14	0.804
Hypothyroidism	03	07	05	0.625
Non-ambulant	0	01	05	0.358
Medications
Opioid	05	22	18	0.003
Iron supplements	23	58	45	0.083
Calcium supplements	18	27	19	0.779
Potassium binders	0	05	02	0.749
Phosphate binders	08	14	21	0.184
Tricyclic antidepressants	01	04	03	0.086

Conclusion

Constipation measured using Rome IV criteria affects around two-third of CKD stage 3-5 patients. Diabetes, hypertension and opioid use has been found to be significantly associated with constipation.

MO515 Table 1:

Constipation symptoms and diagnosis reported in each stage (Rome IV criteria)

Symptom or diagnosis	CKD Stage 3	CKD Stage 4	CKD Stage5	Total
	(n=59)	(n=81)	(n=85)	(n=225)
Straining>25% of defecations	19	35	55	109
Lumpy or hard stool (BSFS type 1/2)	23	44	47	114
Incomplete evacuation	25	32	41	98
Anorectal obstruction/ blockade	7	9	12	28
Manual maneuvers	3	8	6	17
Fewer than 3 bowel movement per week	28	46	59	133
Functional constipation diagnosis	32 (54.2%)	52 (81.3%)	64 (75.3%)	148 (65.8%)
Opioid induced constipation diagnosis	01	09	06	16