Polyethylene glycol plus ascorbic acid for bowel preparation in chronic kidney disease

Jae Min Lee, Bora Keum, In Kyung Yoo, Seung Han Kim, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Myung Gyu Kim, Sang Kyung Jo, Jae Min Lee, Bora Keum, In Kyung Yoo, Seung Han Kim, Hyuk Soon Choi, Eun Sun Kim, Yeon Seok Seo, Yoon Tae Jeen, Hoon Jai Chun, Hong Sik Lee, Soon Ho Um, Chang Duck Kim, Myung Gyu Kim, Sang Kyung Jo

Abstract

The safety of polyethylene glycol plus ascorbic acid has not been fully investigated in patients with renal insufficiency. High-dose ascorbic acid could induce hyperoxaluria, thereby causing tubule-interstitial nephritis and renal failure. This study aims to evaluate the safety and efficacy of polyethylene glycol plus ascorbic acid in patients with chronic kidney disease.We retrospectively reviewed prospectively collected data on colonoscopy in patients with impaired renal function. Patients were divided into 2 groups: 2 L polyethylene glycol plus ascorbic acid (n = 61) and 4 L polyethylene glycol (n = 80). The safety of the 2 groups was compared by assessing the differences in laboratory findings before and after bowel cleansing.The laboratory findings were not significantly different before and after the administration of 2 L polyethylene glycol plus ascorbic acid or 4 L polyethylene glycol. In both groups, the estimated glomerular filtration rate was not influenced by the administration of the bowel-cleansing agent. Patients' reports on tolerance and acceptability were better in the 2 L polyethylene glycol plus ascorbic acid group than in the 4 L polyethylene glycol group.The 2 L polyethylene glycol plus ascorbic acid solution is a safe choice for bowel preparation before colonoscopy in patients with impaired renal function.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

    1. Poon CM, Lee DW, Mak SK, et al. Two liters of polyethylene glycol-electrolyte lavage solution versus sodium phosphate as bowel cleansing regimen for colonoscopy: a prospective randomized controlled trial. Endoscopy 2002; 34:560–563.
    1. Ell C, Fischbach W, Keller R, et al. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing solutions for colonoscopy (HSG-01∗). Endoscopy 2003; 35:300–304.
    1. Huppertz-Hauss G, Bretthauer M, Sauar J, et al. Polyethylene glycol versus sodium phosphate in bowel cleansing for colonoscopy: a randomized trial. Endoscopy 2005; 37:537–541.
    1. Tjandra JJ, Tan J. Which is the optimal bowel preparation for colonoscopy—a meta-analysis. J Gastroenterol Hepatol 2006; 21:A299.
    1. Belsey J, Epstein O, Heresbach D. Systematic review: oral bowel preparation for colonoscopy. Aliment Pharmacol Ther 2007; 25:373–384.
    1. Lien YHH. Is bowel preparation before colonoscopy a risky business for the kidney? Nat Clin Pract Nephrol 2008; 4:606–614.
    1. Russmann S, Lamerato L, Marfatia A, et al. Risk of impaired renal function after colonoscopy: a cohort study in patients receiving either oral sodium phosphate or polyethylene glycol. Am J Gastroenterol 2007; 102:2655–2663.
    1. Russmann S, Lamerato L, Motsko SP, et al. Risk of further decline in renal function after the use of oral sodium phosphate or polyethylene glycol in patients with a preexisting glomerular filtration rate below 60 ml/min. Am J Gastroenterol 2008; 103:2707–2716.
    1. Lim YJ, Hong SJ. What is the best strategy for successful bowel preparation under special conditions? World J Gastroenterol 2014; 20:2741–2745.
    1. Thierry P, Christian B, Denis H, et al. A low-volume polyethylene glycol plus ascorbate solution for bowel cleansing prior to colonoscopy: the NORMO randomised clinical trial. Dig Liver Dis 2013; 45:820–826.
    1. Pontone S, Angelini R, Standoli M, et al. Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol 2011; 17:4689–4695.
    1. Gentile M, De Rosa M, Cestaro G, et al. 2 L PEG plus ascorbic acid versus 4 L PEG plus simethicon for colonoscopy preparation: a randomized single-blind clinical trial. Surg Laparosc Endosc Percutan Tech 2013; 23:276–280.
    1. Rathi S, Kern W, Lau K. Vitamin C-induced hyperoxaluria causing reversible tubulointerstitial nephritis and chronic renal failure: a case report. J Med Case Rep 2007; 1:155.
    1. Payton S. Stones: vitamin C doubles stone risk in men. Nat Rev Urol 2013; 10:184.
    1. Massey LK, Liebman M, Kynast-Gales SA. Ascorbate increases human oxaluria and kidney stone risk. J Nutr 2005; 135:1673–1677.
    1. Baxmann AC, Mendonca CDG, Heilberg IP. Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients. Kidney Int 2003; 63:1066–1071.
    1. Lai EJ, Calderwood AH, Doros G, et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009; 69:620–625.
    1. Wexner SD, Beck DE, Baron TH, et al. A consensus document on bowel preparation before colonoscopy: prepared by a Task Force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopoy (ASGE), and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) (vol 20, pg 1147,2006). Surg Endosc 2006; 20:1161.
    1. Connor A, Tolan D, Hughes S, et al. Consensus guidelines for the safe prescription and administration of oral bowel-cleansing agents. Gut 2012; 61:1525–1532.
    1. Hassan C, Bretthauer M, Kaminski MF, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) guideline. Endoscopy 2013; 45:142–150.
    1. Ho JM, Juurlink DN, Cavalcanti RB. Hypokalemia following polyethylene glycol-based bowel preparation for colonoscopy in older hospitalized patients with significant comorbidities. Ann Pharmacother 2010; 44:466–470.
    1. Nagler J, Poppers D, Turetz M. Severe hyponatremia and seizure following a polyethylene glycol-based bowel preparation for colonoscopy. J Clin Gastroenterol 2006; 40:558–559.
    1. Cohen CD, Keuneke C, Schlemann U, et al. Hyponatraemia as a complication of colonoscopy. Lancet 2001; 357:282–283.
    1. Markowitz GS, Stokes MB, Radhakrishnan J, et al. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: An underrecognized cause of chronic renal failure. J Am Soc Nephrol 2005; 16:3389–3396.
    1. Corporaal S, Kleibeuker JH, Koornstra JJ. Low-volume PEG plus ascorbic acid versus high-volume PEG as bowel preparation for colonoscopy. Scand J Gastroenterol 2010; 45:1380–1386.
    1. Moon CM, Park DI, Choe YG, et al. Randomized trial of 2-L polyethylene glycol + ascorbic acid versus 4-L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting. J Gastroenterol Hepatol 2014; 29:1223–1228.
    1. Adams WJ, Meagher AP, Lubowski DZ, et al. Bisacodyl reduces the volume of polyethylene–glycol solution required for bowel preparation. Dis Colon Rectum 1994; 37:229–233.
    1. Aoun E, Abdul-Baki H, Azar C, et al. A randomized single-blind trial of split-dose PEG-electrolyte solution without dietary restriction compared with whole dose PEG-electrolyte solution with dietary restriction for colonoscopy preparation. Gastrointest Endosc 2005; 62:213–218.
    1. Sharma VK, Steinberg EN, Vasudeva R, et al. Randomized, controlled study of pretreatment with magnesium citrate on the quality of colonoscopy preparation with polyethylene glycol electrolyte lavage solution. Gastrointest Endosc 1997; 46:541–543.
    1. Lamarche J, Nair R, Peguero A, et al. Vitamin C-induced oxalate nephropathy. Int J Nephrol 2011; 2011:146927.
    1. Beloosesky Y, Grinblat J, Weiss A, et al. Electrolyte disorders following oral sodium phosphate administration for bowel cleansing in elderly patients. Arch Intern Med 2003; 163:803–808.
    1. Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol 2001; 96:710–714.
    1. Haapamaki MM, Lindstrom M, Sandzen B. Low-volume bowel preparation is inferior to standard 4 l polyethylene glycol. Surg Endosc 2011; 25:897–901.
    1. Hjelkrem M, Stengel J, Liu M, et al. MiraLAX is not as effective as GoLytely in bowel cleansing before screening colonoscopies. Clin Gastroenterol Hepatol 2011; 9:326–332.
    1. Hookey LC, Depew WT, Vanner SJ. Combined low-volume polyethylene glycol solution plus stimulant laxatives versus standard-volume polyethylene glycol solution: A prospective, randomized study of colon cleansing before colonoscopy. Can J Gastroenterol 2006; 20:101–105.

Source: PubMed

3
Abonnere