Constipation in Chronic Kidney Disease: It Is Time to Bridge the Gap

Abstract

In this narrative review, we briefly describe the general features of constipation, our understanding of its physiopathology, and its diagnosis and treatment, focusing on chronic kidney disease (CKD). Considering that constipation is poorly characterized in CKD, we referred to studies that used the Rome criteria to diagnose constipation in patients to describe a more realistic prevalence based on a standardized tool. A highly variable prevalence of the condition was reported, ranging from 4.5% to 71.7%. The main risk factors associated with constipation reported in these studies were advanced age, low fruit intake, presence of diabetes, and medication use, and the main consequence of constipation in CKD was a worse quality of life. We found a paucity of interventional studies for constipation treatment in CKD; however, in the general population, meta-analyses published in the last decade have reported the beneficial effects of non-pharmacological strategies, which may guide the management of constipated patients with CKD. These strategies include the consumption of fiber, prebiotics, and probiotics, as well as physical exercise and acupuncture. In conclusion, although constipation is a frequent complaint among patients with CKD, there remains a considerable knowledge gap regarding its epidemiology, prognosis, and treatment.