Constipation and Incident CKD : Journal of the American Society of Nephrology (original) (raw)

Clinical Epidemiology

Sumida, Keiichi*; Molnar, Miklos Z.*; Potukuchi, Praveen K.*; Thomas, Fridtjof; Lu, Jun Ling*; Matsushita, Kunihiro; Yamagata, Kunihiro; Kalantar-Zadeh, Kamyar**; Kovesdy, Csaba P.*

*Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;

†Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;

‡Department of Nephrology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan;

§Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan;

‖Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary;

¶Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee;

**Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California, Irvine, Orange, California; and

††Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee

Correspondence: Dr. Csaba P. Kovesdy, Nephrology Section, Memphis Veterans Affairs Medical Center, 1030 Jefferson Avenue, Memphis, TN 38104. Email: [email protected]

Abstract

Constipation is one of the most prevalent conditions in primary care settings and increases the risk of cardiovascular disease, potentially through processes mediated by altered gut microbiota. However, little is known about the association of constipation with CKD. In a nationwide cohort of 3,504,732 United States veterans with an eGFR ≥60 ml/min per 1.73 m2, we examined the association of constipation status and severity (absent, mild, or moderate/severe), defined using diagnostic codes and laxative use, with incident CKD, incident ESRD, and change in eGFR in Cox models (for time-to-event analyses) and multinomial logistic regression models (for change in eGFR). Among patients, the mean (SD) age was 60.0 (14.1) years old; 93.2% of patients were men, and 24.7% were diabetic. After multivariable adjustments, compared with patients without constipation, patients with constipation had higher incidence rates of CKD (hazard ratio, 1.13; 95% confidence interval [95% CI], 1.11 to 1.14) and ESRD (hazard ratio, 1.09; 95% CI, 1.01 to 1.18) and faster eGFR decline (multinomial odds ratios for eGFR slope <−10, −10 to <−5, and −5 to <−1 versus −1 to <0 ml/min per 1.73 m2 per year, 1.17; 95% CI, 1.14 to 1.20; 1.07; 95% CI, 1.04 to 1.09; and 1.01; 95% CI, 1.00 to 1.03, respectively). More severe constipation associated with an incrementally higher risk for each renal outcome. In conclusion, constipation status and severity associate with higher risk of incident CKD and ESRD and with progressive eGFR decline, independent of known risk factors. Further studies should elucidate the underlying mechanisms.