Sumida Keiichi, Yamagata Kunihiro, Kovesdy Csaba P
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Nephrology, University of Tsukuba, Ibaraki, Japan.
Kidney Int Rep. 2019 Nov 13;5(2):121-134. doi: 10.1016/j.ekir.2019.11.002. eCollection 2020 Feb.
Constipation is one of the most common gastrointestinal disorders among patients with chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g., phosphate binders), and multiple comorbidities (e.g., diabetes). Although constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of constipation. The chronic symptoms of constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that constipation is independently associated with adverse clinical outcomes, such as end-stage renal disease (ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of uremic toxins and in acid-base and mineral homeostasis with declining kidney function, the presence of constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for constipation, some of which showing unique renoprotective properties, the adequate management of constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.
便秘是慢性肾脏病(CKD)患者中最常见的胃肠道疾病之一,部分原因在于他们久坐不动的生活方式、低纤维和液体摄入量、同时服用的药物(如磷结合剂)以及多种合并症(如糖尿病)。尽管便秘通常被认为是一种良性的、往往具有自限性的疾病,但最近的证据对这种关于便秘的最常见认知提出了挑战。便秘的慢性症状会对患者的生活质量产生负面影响,并带来相当大的社会和经济负担。此外,最近的流行病学研究表明,便秘与不良临床结局独立相关,如终末期肾病(ESRD)、心血管(CV)疾病和死亡率,这可能是由肠道微生物群的改变和粪便代谢产物生成增加所介导的。鉴于肠道在清除尿毒症毒素以及在肾功能下降时维持酸碱和矿物质稳态方面的重要性,CKD患者中便秘的存在可能会限制甚至排除这些辅助性胃肠道功能,从而可能导致额外的发病率和死亡率增加。随着用于治疗便秘的新型药物类别的出现,其中一些显示出独特的肾脏保护特性,对CKD患者便秘进行充分管理可能会带来超出其传统排便控制的额外治疗益处。然而,CKD患者便秘问题长期以来未得到充分认识,其管理策略也鲜有文献记载。本综述概述了目前对CKD患者便秘的诊断、患病率、病因、结局和治疗的认识,并旨在讨论其新的临床和治疗意义。