Abnormal stool form and bowel dysfunction in patients undergoing hemodialysis: Prevalence, characteristics, and associated factors

 

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https://storage.unitedwebnetwork.com/files/1099/6f6744fa84654170c5671599b0c28e65.pdf
Abnormal stool form and bowel dysfunction in patients undergoing hemodialysis: Prevalence, characteristics, and associated factors

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Kazumi
Kozuka
Kazumi Kozuka kozuka.kazumi.h@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan *
Yosuke Nakagawa ysuke_nkgw@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan -
Norisuke Shimamura rfj9563@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan -
Masahiro Koizumi km9883@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan -
Takao Suga t_suga@mtnet.jp Medical Corporation Showakai Tokyo Japan -
Takatoshi Kakuta kakuta@is.icc.u-tokai.ac.jp Medical Corporation Showakai Tokyo Japan - Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan
Hirotaka Komaba hkomaba@tokai.ac.jp Tokai University School of Medicine Division of Nephrology, Endocrinology and Metabolism Isehara Japan -
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Bowel dysfunction, including constipation and diarrhea, is highly prevalent among patients undergoing hemodialysis, significantly impairing their quality of life. Contributing factors may include uremic toxins, autonomic neuropathy, restrictions on fluid and dietary fiber intake, reduced physical activity, intradialytic ultrafiltration, intestinal hypoperfusion, and medication use. However, few studies have examined the factors associated with bowel dysfunction in this population.

We analyzed baseline data from a prospective cohort of 2,208 patients undergoing maintenance hemodialysis. Data on the Bristol Stool Form Scale (BSFS), bowel movement frequency (times per week), constipation severity (score 0–4), and laxative use were collected. Among them, 2,139 patients with available BSFS data were included in the analyses. Ordinal logistic regression was employed to identify factors associated with BSFS scores. Multinomial logistic regression was also performed to identify factors associated with hard stools (BSFS 1–3) and loose stools (BSFS 5–7), using normal stools (BSFS 4) as the reference category.

The mean BSFS score was 3.8 ± 1.2, and the average bowel movement frequency was 7.1 ± 4.5 per week. Overall, 38% of patients reported constipation, and 29% used laxatives. Lower BSFS scores (indicating harder stools) were associated with fewer bowel movements, more frequent subjective constipation, and less frequent laxative use. In ordinal logistic regression analysis, lower BSFS scores were independently associated with higher serum albumin levels, use of calcium channel blockers (CCBs), use of glucagon–like peptide–1 (GLP–1) receptor agonists, and absence of laxative use. Similar results were observed in multinomial logistic regression analysis.

Among patients undergoing hemodialysis, the use of CCBs and GLP–1 receptor agonists was independently associated with harder stools, suggesting that these medications may contribute to constipation in this population.

Kewords