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Desloovere A, Polderman N, Renken-Terhaerdt J, Shaw V, Anderson C, Greenbaum LA, Nelms CL, Qizalbash L, Stabouli S, Tuokkola J, Warady BA, Vande Walle J, Paglialonga F, Shroff R, Snauwaert E. The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce. J Ren Nutr 2024:S1051-2276(24)00095-5. [PMID: 38866350 DOI: 10.1053/j.jrn.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.
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Affiliation(s)
- An Desloovere
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium
| | - Nonnie Polderman
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - José Renken-Terhaerdt
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vanessa Shaw
- Department of Pediatric Nephrology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Caroline Anderson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Larry A Greenbaum
- Department of Pediatric Nephrology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Christina L Nelms
- Department of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Leila Qizalbash
- Department of Pediatric Nephrology, Great Northern Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Stella Stabouli
- Pediatric Nephrology Unit, 1st Pediatric Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jetta Tuokkola
- Children's Hospital and Clinical Nutrition Unit, Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bradley A Warady
- Department of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium
| | - Fabio Paglialonga
- Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- Department of Pediatric Nephrology, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Evelien Snauwaert
- Department of Pediatric Nephrology, Ghent University Hospital, Member of the European Reference Network for Rare Kidney Disease (ERKNet), Ghent, Belgium.
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Wan M, King L, Baugh N, Arslan Z, Snauwaert E, Paglialonga F, Shroff R. Gutted: constipation in children with chronic kidney disease and on dialysis. Pediatr Nephrol 2023; 38:3581-3596. [PMID: 36622442 PMCID: PMC10514126 DOI: 10.1007/s00467-022-05849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 01/10/2023]
Abstract
Functional constipation is a common problem in otherwise healthy children. Children with chronic kidney disease (CKD) and on dialysis have additional disease-related risk factors including the uremic milieu, fluid and dietary restrictions, and decreased physical activity, as well as treatment-related risk factors such as dialysis therapy and polypharmacy that contribute to and compound the problem. Constipation causes significant distress for children and their caregivers. In children on peritoneal dialysis, severe constipation can impede catheter function and ultrafiltration. Accumulating evidence points to a possible bidirectional relationship between constipation and CKD, potentially mediated by gut dysbiosis with consequent increased generation of gut-derived uremic toxins and disruption of intestinal epithelium integrity leading to translocation of noxious luminal contents into the circulation inducing systemic inflammation. Effective management of constipation is required but there is little published data on the safety and effectiveness of treatments in adults or children with CKD. In this review, we discuss the diagnosis and epidemiology of functional constipation, provide an overview of its pathophysiology, summarize the therapeutic management, and reflect on the challenges in children with CKD.
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Affiliation(s)
- Mandy Wan
- Evelina Pharmacy Department, Evelina London Children's Hospital, NHS Foundation Trust, Guy's and St ThomasWestminster Bridge Road, London, SE1 7EH, UK.
- Institute of Pharmaceutical Science, King's College London, London, UK.
| | - Lillian King
- UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Natasha Baugh
- UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | - Zainab Arslan
- UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
| | | | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rukshana Shroff
- UCL Great Ormond Street Hospital for Children and Institute of Child Health, London, UK
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Yamamoto J, Yamamoto M, Hara H, Hiroi Y. Relation between laxative use and risk of major bleeding in patients with atrial fibrillation and heart failure. Heart Vessels 2023; 38:938-948. [PMID: 36799967 DOI: 10.1007/s00380-023-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023]
Abstract
Constipation has been reported to increase the risk of cardiovascular mortality. Patients with atrial fibrillation (AF) and heart failure (HF) have more comorbidities and an increased bleeding risk. However, it remains unclear whether constipation is associated with an increased risk of incident bleeding complications in AF with HF. Here, we investigated the association between constipation requiring laxatives and major bleeding in AF and HF. We retrospectively analyzed the medical records of 370 consecutive patients hospitalized for AF and congestive HF. Constipation was defined as regularly taking laxatives or having at least two prescriptions for a ≥ 30-day supply of laxatives. Sixty patients experienced major bleeding events during a median follow-up of 318 days. The most common sites of bleeding were lower gastrointestinal (28%, 17/60), upper gastrointestinal (27%, 16/60), and intracranial (20%, 12/60). There were 33 (55%) patients with constipation in the bleeding group and 107 (35%) in the non-bleeding group (P = 0.004). Multivariate Cox regression analysis adjusted for HAS-BLED score, hemoglobin, and direct oral anticoagulant use showed that constipation (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11-3.08; p = 0.019) was a significant risk factor for major bleeding. We found a significant association between constipation requiring laxatives and major bleeding in patients with AF and HF. These findings indicate the need for constipation prevention in these patients to avoid reliance on invasive defecation management, including laxatives.
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Affiliation(s)
- Jumpei Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan.
| | - Masaya Yamamoto
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Hisao Hara
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
| | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku, Tokyo, 162-8655, Japan
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Hoang Anh T, Nguyen PA, Duong A, Chiu IJ, Chou CL, Ko YC, Chang TH, Huang CW, Wu MS, Liao CT, Hsu YH. Contact Laxative Use and the Risk of Arteriovenous Fistula Maturation Failure in Patients Undergoing Hemodialysis: A Multi-Center Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116842. [PMID: 35682426 PMCID: PMC9180587 DOI: 10.3390/ijerph19116842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Laxatives are commonly prescribed for constipation management; however, they are recognized as an independent factor associated with cardiovascular diseases. Arteriovenous fistula (AVF) is the closest to the ideal model of hemodialysis (HD) vascular access and part of the cardiovascular system. Our study aims to explore the association of contact laxative use with AVF maturation outcomes in patients undergoing HD. We conducted a multi-center cohort study of 480 contact laxative users and 472 non-users who had undergone initial AVF creation. All patients were followed until the outcomes of AVF maturation were confirmed. Multivariable logistic regression models were performed to evaluate the risk of AVF maturation failure imposed by laxatives. Here, we found that patients who used contact laxatives were significantly associated with an increased risk of AVF maturation failure compared to non-users (adjusted odds ratio, 1.64; p = 0.003). Notably, the risk of AVF maturation failure increased when increasing their average daily doses and cumulative treatment days. In conclusion, our study found a significant dose- and duration-dependent relationship between contact laxative use and an increased risk of AVF maturation failure. Thus, laxatives should be prescribed with caution in this population. Further studies are needed to validate these observations and investigate the potential mechanisms.
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Affiliation(s)
- Trung Hoang Anh
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- Nephro-Urology and Dialysis Center, Bach Mai Hospital, Ha Noi 100000, Vietnam
| | - Phung-Anh Nguyen
- Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei 110, Taiwan;
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan 330, Taiwan
| | - Anh Duong
- Macquarie Business School, Macquarie University, Sydney, NSW 2109, Australia;
| | - I-Jen Chiu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (I.-J.C.); (M.-S.W.)
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
| | - Chu-Lin Chou
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
- National Defense Medical Center, Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Hsin Kuo Min Hospital, Taoyuan City 330, Taiwan
| | - Yu-Chen Ko
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan;
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (C.-W.H.)
| | - Chih-Wei Huang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (T.-H.C.); (C.-W.H.)
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (I.-J.C.); (M.-S.W.)
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
| | - Chia-Te Liao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (I.-J.C.); (M.-S.W.)
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
- Correspondence: (C.-T.L.); (Y.-H.H.); Tel.: +886-2-2249-0088 (ext. 2736) (C.-T.L.)
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei City 235, Taiwan; (I.-J.C.); (M.-S.W.)
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan;
- TMU-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 110, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Hsin Kuo Min Hospital, Taoyuan City 330, Taiwan
- Correspondence: (C.-T.L.); (Y.-H.H.); Tel.: +886-2-2249-0088 (ext. 2736) (C.-T.L.)
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