Gastrointestinal Health in Chronic Kidney Disease Patients

Chronic kidney disease (CKD) is associated with a high burden of gastrointestinal (GI) symptoms that range from constipation and dyspepsia to nausea and altered bowel habits. These disturbances arise from multiple interrelated factors, including impaired renal clearance of metabolites, medication effects, dietary restrictions and systemic inflammation. Accumulation of uremic toxins disrupts colonic motility and mucosal integrity, while dietary phosphate and potassium binding agents further modify gut function. Changes in the gut microbiota, often termed gut dysbiosis, contribute to increased intestinal permeability and the generation of pro-inflammatory compounds. Together, these processes compromise nutrient absorption, exacerbate malnutrition and diminish quality of life. Effective management requires a holistic approach that integrates nutritional guidance, modulation of the gut ecosystem and tailored pharmacotherapy, recognising the bidirectional gut-kidney axis in driving both gastrointestinal and renal outcomes.

Research from Nature Portfolio

Analysis of a nationwide Korean cohort has revealed that constipation affects nearly one third of patients with CKD and increases markedly with advancing stages of renal impairment. Those on peritoneal or haemodialysis exhibited the highest rates of bowel dysfunction, whereas transplant recipients approximated early-stage CKD prevalence. Patterns of laxative use varied by disease severity, with osmotic agents predominant in advanced CKD and lower utilisation of bulking agents and magnesium salts. A notable association emerged between constipation and the prescription of certain antipsychotic and neurological medications. These findings underscore the need for stage-specific strategies to prevent and treat constipation, and for international guidelines to reflect real-world prescribing trends.

Gastrointestinal Health in Chronic Kidney Disease Patients publication trend

The graph below shows the total number of articles in gastrointestinal health in chronic kidney disease patients across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): Progressive decline in renal function classified into five stages based on estimated glomerular filtration rate.

Gut dysbiosis: Imbalance in intestinal microbial communities that can promote inflammation and impair barrier function.

Uremic toxins: Metabolites such as indoxyl sulphate and p-cresyl sulphate that accumulate in CKD and disrupt gut motility and mucosal health.

Peritoneal dialysis (PD): A form of renal replacement therapy using the peritoneum as a semipermeable membrane to remove waste and fluid.

Osmotic agents: Laxatives that draw water into the bowel to soften stool and facilitate defecation, commonly used in advanced stages of CKD.

References

1. Real-world evidence of constipation and laxative use in the Korean population with chronic kidney disease from a common data model. Scientific Reports (2024).
2. Dietary Patterns, Dietary Adequacy and Nutrient Intake in Adults Commencing Peritoneal Dialysis: Outcomes from a Longitudinal Cohort Study. Nutrients (2024).
3. Patient Preferences for the Management of Gastrointestinal Symptoms in Kidney Transplantation: a Discrete Choice Experiment. Kidney International Reports (2023).
4. Distal Colon Motor Dysfunction in Mice with Chronic Kidney Disease: Putative Role of Uremic Toxins. Toxins (2018).