Laxative use may lower the risk of hyperkalemia in patients with advanced chronic kidney disease (CKD) not yet on dialysis, a new study finds.

Patients with advanced CKD experience increased intestinal potassium excretion as a compensatory mechanism for failing kidneys, Csaba P. Kovesdy, MD, of Memphis Veterans Affairs Medical Center in Memphis, Tennessee, and colleagues explained in the Journal of the American Society of Nephrology. They also often experience constipation partly due to a low-fiber diet to prevent hyperkalemia. Laxatives, which promote faster intestinal transit, possibly reduce potassium absorption. 

Among 36,116 United States mostly male veterans with advanced CKD, 15,842 (5.0%) had hyperkalemia and 12,787 (4.0%) had hypokalemia in the year prior to end-stage kidney disease (ESKD). Time-varying laxative use was significantly associated with 21% lower adjusted odds of hyperkalemia (serum potassium greater than 5.5 mEq/L) compared with nonuse, the investigators reported. Conversely, the team found no relationship between laxative use and hypokalemia (serum potassium less than 3.5 mEq/L). Study results did not differ by type of laxative, including stool softeners, hyperosmotics, and stimulants.

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“Our findings suggest the putative role of constipation in potassium disarrays and, with a careful consideration for the risk-benefit profiles, the therapeutic potential of laxatives or other stool-softening interventions for hyperkalemia management in advanced CKD,” Dr Kovesdy’s team concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Sumida K, Dashputre AA, Potukuchi PK, et al. Laxative use and risk of dyskalemia in patients with advanced CKD transitioning to dialysis. Published online February 5, 2021. J Am Soc Nephrol. doi:10.1681/ASN.2020081120