Constipation in Patients With Chronic Kidney Disease.

IF 3.3 3区 医学 Q2 CLINICAL NEUROLOGY
Ra Ri Cha, Seon-Young Park, Michael Camilleri
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引用次数: 1

Abstract

Constipation is a frequent symptom in patients with chronic kidney disease (CKD). This review outlines the mechanisms and management of constipation in patients with CKD from a physician's perspective. Common causes of constipation in patients with CKD include concomitant medications, low dietary fiber intake, water-restricted diet, lack of physical activity, altered gut microbiota, and reduced gastrointestinal motility. Constipation has a negative impact on overall health, and, in particular, the presence of constipation has been associated with worsening kidney function and increased risk of developing advanced stages of CKD. Although lifestyle and dietary modifications may not always be practical for patients with CKD, they are recommended because they are beneficial as they lower mortality in patients with CKD. The use of laxatives containing magnesium salts, bulking agents, and osmotic laxatives may have insufficient efficacy and may be associated with adverse effects. In contrast, lactulose and lubiprostone have been shown to exhibit reno-protective effects. Linaclotide and plecanatide have very limited systemic absorption and appear safe in patients with CKD. Tenapanor reduces paracellular intestinal phosphate absorption in addition to blocking sodium uptake by enterocytes, and provides additional benefit in patients patients with CKD who have hyperphosphatemia and constipation. Prucalopride leads to improvements in bowel function and constipation-related symptoms in cases in which response to conventional laxatives are inadequate. However, the dose of prucalopride should be reduced to 1 mg once daily for patients with CKD. In conclusion, there are important advances on the impact and treatment of constipation in patients with CKD.

慢性肾脏病患者的便秘。
便秘是慢性肾脏疾病(CKD)患者的常见症状。这篇综述从医生的角度概述了CKD患者便秘的机制和治疗方法。CKD患者便秘的常见原因包括合并用药、低膳食纤维摄入、限制饮水、缺乏体育活动、肠道微生物群改变和胃肠动力下降。便秘对整体健康有负面影响,尤其是便秘的存在与肾功能恶化和CKD晚期风险增加有关。尽管生活方式和饮食的改变可能并不总是适用于CKD患者,但建议使用它们,因为它们有益于降低CKD患者的死亡率。使用含有镁盐、填充剂和渗透性泻药的泻药可能疗效不足,并可能产生不良反应。相反,乳果糖和鲁比前列酮已显示出对雷诺的保护作用。利那洛肽和普乐那肽的全身吸收非常有限,在CKD患者中似乎是安全的。Tenapanor除了阻断肠细胞对钠的吸收外,还能减少细胞旁肠道磷酸盐的吸收,并为患有高磷血症和便秘的CKD患者提供额外的益处。在对传统泻药反应不足的情况下,普卡必利可改善肠功能和便秘相关症状。然而,对于CKD患者,普卡必利的剂量应减少到1 mg,每天一次。总之,在CKD患者便秘的影响和治疗方面取得了重要进展。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Neurogastroenterology and Motility
Journal of Neurogastroenterology and Motility GASTROENTEROLOGY & HEPATOLOGY-CLINICAL NEUROLOGY
CiteScore
6.30
自引率
8.80%
发文量
96
期刊介绍: Journal of Neurogastroenterology and Motility (J Neurogastroenterol Motil) is a joint official journal of the Korean Society of Neurogastroenterology and Motility, the Thai Neurogastroenterology and Motility Society, the Japanese Society of Neurogastroenterology and Motility, the Indian Motility and Functional Disease Association, the Chinese Society of Gastrointestinal Motility, the South East Asia Gastro-Neuro Motility Association, the Taiwan Neurogastroenterology and Motility Society and the Asian Neurogastroenterology and Motility Association, launched in January 2010 after the title change from the Korean Journal of Neurogastroenterology and Motility, published from 1994 to 2009.
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