Real-world evidence of constipation and laxative use in the Korean population with chronic kidney disease from a common data model

Abstract

Constipation is a highly prevalent gastrointestinal disorder in patients with chronic kidney disease (CKD). However, our understanding of its epidemiology and management in CKD is limited. We aimed to explore real-world data on constipation and laxative use in patients with CKD in a nationwide population-based cohort from the Korean Health Insurance Review and Assessment-National Patient Sample database. This study analyzed retrospective health claims data in Korea from 2012 to 2017 that were transformed into the Observational Medical Outcomes Partnership Common Data Model. The pooled proportion of constipation diagnoses was 30.5% in all patients with CKD and 15.9%, 16.5%, 17.4%, 29.9%, and 43.3% in patients with CKD stages 1-5, respectively, suggesting a higher prevalence in advanced CKD. Patients receiving peritoneal dialysis or hemodialysis had the highest prevalence of constipation, while transplant recipients showed a prevalence comparable to that of patients with early CKD. Patients with CKD had a significantly higher risk of constipation than age- and sex-matched non-CKD individuals (range of odds ratio [OR]:1.66-1.90). Laxative prescribing patterns differed by CKD severity. Osmotic agents were prescribed in more than half of patients with advanced CKD, while magnesium salts and bulking agents were prescribed less frequently. The CKD patients with constipation were more likely to be prescribed constipation-inducing medications, including antipsychotic and neurological medications. Our findings provide real-world constipation and laxative prescription status in the Korean CKD population, revealing a significantly higher risk of constipation and different laxative prescribing patterns in patients with CKD.

Figure 1

Proportion of constipation and laxative prescriptions in patients with chronic kidney disease (CKD). (A) Constipation diagnosis according to the CKD stages. (B) Laxative use according to the CKD stages. (C) Constipation diagnosis in patients with end-stage kidney disease (ESKD) including kidney transplant (KT) recipients. (D) Laxative use in patients with ESKD including KT recipients.

Figure 2

Treatment pathways for laxatives in patients with (A) non-chronic kidney disease (non-CKD), (B) mild chronic kidney disease (CKD) (CKD stages 1–3), (C) advanced CKD (CKD stages 4–5), (D) peritoneal dialysis (PD), (E) hemodialysis (HD), and (F) kidney transplantation. Sunburst plots are drawn using data in 2017. Plots using data in 2012–2016 are presented in Supplementary Fig. 1–5. PEG = polyethylene glycol.