S1277 A Systematic Review of Gastrointestinal Symptoms in Patients on Peritoneal Dialysis

Abstract

INTRODUCTION: The effects of peritoneal dialysis on gastrointestinal system are insufficiently reported and poorly understood in current literature. Frequently reported symptoms include constipation, diarrhea, bloating, abdominal pain, indigestion and nausea which affect the quality of life of patients. The proposed mechanism for gastric symptoms is delayed gastric emptying (regardless of dialysate composition or volume), while lower GI symptoms like constipation have been hypothesized secondary to low fiber intake, poor hydration, and medications. The objective of this review is to understand the burden of GI symptoms in peritoneal dialysis patients and identify potentially reversible factors contributing to them. METHODS: A systematic review was conducted using Pubmed, Scopus, Google Scholar, Web of Science, Cochrane, CINAHL, and EMBASE databases between 1998 and 2019. Data was analyzed in Excel and verified by PRISMA. Studies with adults on maintenance peritoneal dialysis over 3 months with reported or measured outcomes of gastrointestinal symptoms were included. RESULTS: Eleven studies covering 1243 patients from seven countries met the inclusion criteria between the years 1998 to 2019 (Table 1). Sample sizes ranged from 19 to 204. The mean age of participants was 57 years with M:F ratio of 1.38. Constipation was the most consistently reported/studied symptom with prevalence ranging from 14.2% to 90.3% across 7 studies. Eating dysfunction/anorexia had a prevalence ranging from 43.0 to 72.7% across 5 studies. Other symptoms included reflux, abdominal pain, and indigestion. Two studies reported, “severe GI symptoms and “varying degrees of GI symptoms” with a prevalence of 39.2% and 57.9% respectively. CONCLUSION: The importance and prevalence of GI symptoms in PD patients were highlighted in this study. It also shed light on an inadequate understanding of the causation of these symptoms and the role of diet and medications which needs further directed through multicentric studies. Drugs such as phosphate binders and laxatives which PD patients are commonly prescribed affect GI health. Limitations of the study included nearly 8 studies not considering the role of medications and/or diet. There was only one study on quantitative nutritional data and the rest did not account for dietary intake, which could undermine the potential of dietary intervention in these patients. The lack of standardized tools for diagnosis was apparent and contributed to heterogeneity in symptom reporting and hence prevalence.Table 1