{"title":"The coexistence of constipation and diarrhea is associated with the development of chronic kidney disease: a 10-year cohort study.","authors":"Kazuma Mori, Marenao Tanaka, Yukinori Akiyama, Koki Abe, Keitaro Nishizawa, Hiroki Aida, Yutaka Kawano, Yutaka Okagawa, Rie Matsumori, Kei Nakata, Itaru Hosaka, Hidemichi Kouzu, Nagisa Hanawa, Tatsuya Sato, Masato Furuhashi","doi":"10.1007/s10157-026-02959-x","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The gut-kidney axis is a potential mechanism underlying kidney dysfunction. However, the relationship between chronic kidney disease (CKD) and bowel habit subtypes, especially the coexistence of constipation and diarrhea, remains unknown.</p><p><strong>Methods: </strong>We investigated the association of bowel habit subtypes including the no-constipation/diarrhea, constipation-only, diarrhea-only and coexisting constipation/diarrhea groups with new onset of CKD during a 10-year follow-up period in 14,876 Japanese adults (men/women: 9,620/5,256, mean age: 47 years) who underwent annual health examinations.</p><p><strong>Results: </strong>During a median follow-up of 7.0 years, 2,281 participants (men/women: 1,571/710) developed CKD. Multivariable Cox proportional hazards models analysis after adjustment for age, sex and several confounders showed that hazard ratio (HR) for the development of CKD was significantly higher in the coexisting constipation/diarrhea group (HR [95% confidence interval]: 1.24 [1.06-1.46], p = 0.008), but not the constipation-only group or diarrhea-only group, than in the no-constipation/diarrhea group. Sex-stratified analyses showed that the adjusted HR in women, but not in men, was significantly higher in the constipation-only and coexisting constipation/diarrhea groups than in the no-constipation/diarrhea group, though the interaction by sex was not statistically significant (p = 0.118). In the mutually adjusted analysis using frequency of constipation/diarrhea, frequent constipation was independently associated with the development of CKD. The addition of bowel habit subtypes into traditional risk factors for CKD significantly improved the discriminatory capacity.</p><p><strong>Conclusions: </strong>The coexistence of constipation and diarrhea is independently associated with an increased risk for the development of CKD. The bowel habit subtype provides clinically relevant information regarding future risk for CKD.</p>","PeriodicalId":10349,"journal":{"name":"Clinical and Experimental Nephrology","volume":" ","pages":""},"PeriodicalIF":2.4000,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10157-026-02959-x","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The gut-kidney axis is a potential mechanism underlying kidney dysfunction. However, the relationship between chronic kidney disease (CKD) and bowel habit subtypes, especially the coexistence of constipation and diarrhea, remains unknown.
Methods: We investigated the association of bowel habit subtypes including the no-constipation/diarrhea, constipation-only, diarrhea-only and coexisting constipation/diarrhea groups with new onset of CKD during a 10-year follow-up period in 14,876 Japanese adults (men/women: 9,620/5,256, mean age: 47 years) who underwent annual health examinations.
Results: During a median follow-up of 7.0 years, 2,281 participants (men/women: 1,571/710) developed CKD. Multivariable Cox proportional hazards models analysis after adjustment for age, sex and several confounders showed that hazard ratio (HR) for the development of CKD was significantly higher in the coexisting constipation/diarrhea group (HR [95% confidence interval]: 1.24 [1.06-1.46], p = 0.008), but not the constipation-only group or diarrhea-only group, than in the no-constipation/diarrhea group. Sex-stratified analyses showed that the adjusted HR in women, but not in men, was significantly higher in the constipation-only and coexisting constipation/diarrhea groups than in the no-constipation/diarrhea group, though the interaction by sex was not statistically significant (p = 0.118). In the mutually adjusted analysis using frequency of constipation/diarrhea, frequent constipation was independently associated with the development of CKD. The addition of bowel habit subtypes into traditional risk factors for CKD significantly improved the discriminatory capacity.
Conclusions: The coexistence of constipation and diarrhea is independently associated with an increased risk for the development of CKD. The bowel habit subtype provides clinically relevant information regarding future risk for CKD.
期刊介绍：
Clinical and Experimental Nephrology is a peer-reviewed monthly journal, officially published by the Japanese Society of Nephrology (JSN) to provide an international forum for the discussion of research and issues relating to the study of nephrology. Out of respect for the founders of the JSN, the title of this journal uses the term “nephrology,” a word created and brought into use with the establishment of the JSN (Japanese Journal of Nephrology, Vol. 2, No. 1, 1960). The journal publishes articles on all aspects of nephrology, including basic, experimental, and clinical research, so as to share the latest research findings and ideas not only with members of the JSN, but with all researchers who wish to contribute to a better understanding of recent advances in nephrology. The journal is unique in that it introduces to an international readership original reports from Japan and also the clinical standards discussed and agreed by JSN.
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