Background. Constipation is highly prevalent in patients with chronic kidney disease
(CKD), particularly among those with end-stage renal disease (ESRD), partly due to
their dietary restrictions, comorbidities and medications. Laxatives are typically
used for constipation management; however, little is known about laxative use and
its associated factors in patients with advanced CKD transitioning to ESRD. Methods.
In a retrospective cohort of 102477 US veterans transitioning to dialysis between
October 2007 and March 2015, we examined the proportion of patients who filled a prescription
for any type of laxative within each 6-month period over 36 months pre- and post-transition
to ESRD. Factors associated with laxative use during the last 1-year pre-ESRD period
were identified by multivariable logistic regression. Results. The proportion of patients
prescribed laxatives increased as patients progressed to ESRD, peaking at 37.1% in
the 6months immediately following ESRD transition, then remaining fairly stable throughout
the post-ESRD transition period. Among laxative users, stool softeners were the most
commonly prescribed (similar to 30%), followed by hyperosmotics (similar to 20%),
stimulants (similar to 10%), bulk formers (similar to 3%), chloride channel activator
(<1%) and several combinations of these. The use of anticoagulants, oral iron supplements,
non-opioid analgesics, antihistamines and opioid analgesics were among the factors
independently associated with pre-ESRD laxative use. Conclusion. The use of laxatives
increased considerably as patients neared transition to ESRD, likely mirroring the
increasing burden of drug-induced constipation during the ESRD transition period.
Findings may provide novel insight into better management strategies to alleviate
constipation symptoms and reduce medication requirements in patients with advanced
CKD.
