Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are more likely to develop in individuals with constipation than in those with normal bowel movements, according to a new study published online in the Journal of the American Society of Nephrology.

More severe constipation, defined as using more than one laxative, was associated with increasing risks of CKD and its progression. 

Csaba P. Kovesdy, MD, of the Memphis Veterans Affairs Medical Center in Tennessee, and colleagues identified the correlation after examining a nationwide cohort of 3,504,732 mostly male US veterans (average age 60) with an estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73 m2 and above. The investigators found that faster declines in estimated glomerular filtration rate (eGFR) were linked with each renal outcome over 7 years of follow up. Constipation was associated with 13% increased odds of CKD and 9% increased odds of ESRD.

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The researchers adjusted for known risk factors linked with CKD progression and constipation, such as diabetes (which affected a quarter of patients), use of nonsteroidal anti-inflammatory drugs, and lack of physical exercise. They also adjusted for hypertension, antihypertensive medication, bowel disorders, hospitalizations, and a range of other relevant factors.

Recent research has suggested a relationship between chronic constipation and cardiovascular disease, possibly mediated by inflammation caused by altered gastrointestinal microbiota: “Our findings highlight the plausible link between the gut and the kidneys and provide additional insights into the pathogenesis of kidney disease progression,” Dr Kovesdy, stated in a release.

As constipation is a common condition, the study has important potential clinical implications. “When evaluating a patient with constipation and reduced kidney function in clinical practice, it is also important for health care providers to acknowledge the excess risk of kidney damage caused by dehydration and use (especially over the counter use) of nonsteroidal anti–inflammatory drugs,” Dr Kovesdy, a Renal & Urology News editorial advisory board member, and colleagues wrote. “Careful observation of kidney function trajectory may, thus, be required…”

Since the study was observational, it could not prove that constipation spurs renal decline. Future research is necessary to clarify the relationship. If confirmed, treating constipation with probiotics, lifestyle adjustments, and avoidance of laxative overuse might prove helpful, the investigators suggested.

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1. Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and Incident CKD. J Am Soc Nephrol 28, 2016. doi: 10.1681/ASN.2016060656.

2. Study Uncovers Link Between Constipation and Kidney Disease. American Society of Nephrology. November 10, 2016.