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Constipation and clinical outcomes in peritoneal dialysis: Results from Thailand PDOPPS |
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| Authors: | Guttiga Halue Huttaporn Tharapanich Jeerath Phannajit Talerngsak Kanjanabuch Athiphat Banjongjit Pichet Lorvinitnun Suchai Sritippayawan Wichai Sopassathit Ussanee Poonvivatchaikarn Somphon Buranaosot Wanida Somboonsilp Pimpong Wongtrakul Chanchana Boonyakrai Surapong Narenpitak Sajja Tatiyanupanwong Wadsamon Saikong Sriphrae Uppamai Setthapon Panyatong Rutchanee Chieochanthanakij Niwat Lounseng Angsuwarin Wongpiang Worapot Treamtrakanpon Peerapach Rattanasoonton Narumon Lukrat Phichit Songviriyavithaya Uraiwan Parinyasiri Piyarat Rojsanga Patnarin Kanjanabuch Pongpratch Puapatanakul Krit Pongpirul David W. Johnson Jeffrey Perl Roberto Pecoits-Filho Vuddhidej Ophascharoensuk Kriang Tungsanga Thailand PDOPPS Steering Committee |
| Affiliation: | 1. Department of Medicine, Phayao Hospital, Phayao, Thailand;2. Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand;3. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;4. Nephrology Unit, Department of Medicine, Vichaiyut Hospital, Bangkok, Thailand;5. Department of Medicine, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand;6. Division of Nephrology, Department of Internal Medicine, Siriraj Hospital, Bangkok, Thailand;7. Division of Nephrology, Department of Internal Medicine, Pranangklao Hospital, Nonthaburi, Thailand;8. Nephrology Clinic, Department of Internal Medicine, Nakhon Pathom Hospital, Nakhon Pathom, Thailand;9. Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand;10. Division of Nephrology, Department of Internal Medicine, Chaoprayayomraj Hospital, Suphanburi, Thailand;11. Department of Medicine, King Taksin Memorial Hospital, Bangkok Metropolitan Administration, Bangkok, Thailand;12. Renal Unit, Department of Internal Medicine, Udonthani Hospital, Udon Thani, Thailand;13. Division of Nephrology, Department of Internal Medicine, Chaiyaphum Hospital, Chaiyaphum, Thailand;14. CAPD Clinic, Department of Internal Medicine, Mukdahan Hospital, Mukdahan, Thailand;15. Department of Internal Medicine, Sukhothai Hospital, Sukhothai, Thailand;16. Kidney Center, Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand;17. Dialysis Unit, Department of Medicine, Sawanpracharak Hospital, Nakhon Sawan, Thailand;18. Department of Medicine, Trang Hospital, Trang, Thailand;19. CAPD Unit, Medical Service Department, Pong Hospital, Phayao, Thailand;20. Department of Medicine, Chaophaya Abhaibhubejhr Hospital, Prachin Buri, Thailand;21. Department of Medicine, Trat Hospital, Trat, Thailand;22. Medical Staff Organization, KhueangNai Hospital, Ubon Ratchatani, Thailand;23. Division of Nephrology, Department of Medicine, Amnatcharoen Hospital, Amnatcharoen, Thailand;24. Kidney diseases clinic, Department of internal medicines, Songkhla Hospital, Songkhla, Thailand;25. Department of Oral Medicine, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand;26. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Peritoneal Dialysis Excellent Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand;27. Department of Preventive and Social Medicine and Center of Excellence in Preventive & Integrative Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand;28. Department of Kidney and Transplant Services, Division of Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia;29. St. Michael's Hospital, Toronto, Ontario, Canada;30. Pontifical Catholic University, of Parana, Curitiba, Brazil;31. Division of Nephrology, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand |
| Abstract: | BackgroundPatient-reported outcome measures (PROMs) are widely recognized as valuable predictors of clinical outcomes in peritoneal dialysis (PD). Our study aimed to explore the connections between patient-reported constipation and clinical outcomes.MethodsWe assessed constipation in patients across 22 facilities participating in the Thailand Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017. Constipation diagnosis utilized objective assessment tools such as the Bristol stool form scale (BSFS) and a self-reported questionnaire known as the constipation severity score (CSS). The BSFS is a 7-level scale that visually inspects feces based on texture and morphology, while the CSS measures constipation duration and severity using a 5-point Likert scale for various factors. We employed Cox proportional hazards model regression to determine the associations between constipation and clinical outcomes, including mortality, hemodialysis (HD) transfer and peritonitis.ResultsAmong 975 randomly selected PD patients from 22 facilities, 845 provided written informed consent, and 729 completed CSS questionnaire. Constipation was prevalent in the PD population (13%), particularly among older patients, those who were caregiver dependent, had diabetes and poorer nutritional status (indicated by lower time-averaged serum albumin, potassium, creatinine and phosphate concentrations). Twenty-seven percent of which experiencing symptoms of constipation for over a year. Notably, self-reported constipation at baseline was significantly associated with a shorter time to first peritonitis and higher rates of peritonitis and death. However, no significant association was found between constipation and HD transfer after adjusting for various factors, including age, gender, PD vintage, comorbidities, shared frailty by study sites and serum albumin.ConclusionPatient-reported constipation independently correlated with increased risks of peritonitis and all-cause mortality, though no such correlation was observed with HD transfer. These findings underscore the need for further investigation to identify effective interventions for constipation in PD patients. |
| Keywords: | Bristol stool form scale constipation patient survival PDOPPS peritonitis |