Chronic kidney disease (CKD) is a serious condition that must be managed to avoid kidney failure. Constipation is one complication that can make it worse over time. A recent study finds that the constipation drug lubiprostone can positively impact kidney function.
Kidney Disease Facts
- 20 percent of Black adults in the US have CKD
- Two common conditions attributed to CKD are hypertension and diabetes
- About 1 in 3 people with diabetes and 1 in 5 people with hypertension have kidney disease
- CKD is slightly more common in women than in men, but end-stage kidney disease (ESKD) is more common in men
- Black people are more likely than other races to develop CKD
What Prompted the Study?
Scientists have been on a quest to improve kidney function for years, with modifications to both diet and pharmaceutical interventions. Current treatments for CKD failed to remove uremic toxins, which are crucial for reversing kidney damage. Uremic acid is what builds up in the bloodstream when the kidneys start to fail. So far, treatments may slow down damage that can lead to end-stage kidney disease, but nothing can turn back the clock.
The study’s main goal was to determine if lubiprostone reduced the blood toxin indoxyl sulfate and to monitor any changes in kidney function.
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How Could Lubiprostone Help?
This particular laxative may improve gut health, which can increase kidney function.
The phase 2, randomized, double-blind, placebo-controlled trial was conducted across Japan at nine centers between 2016 and 2019. It included 150 patients with stage 3b and stage 4 chronic kidney disease. The average age of the patients was 63, and women accounted for 34 percent of participation. Everyone was of Asian descent. Participants either received lubiprostone or a placebo for 24 weeks.
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Results showed that lubiprostone had no direct effect on the level of toxins. However, kidney function did improve. The explanation is that the drug affected certain gut bacteria, which helps to support kidney health.
By improving the gut microbiome, spermidine was increased, which is a compound that supports kidney health. This is the first time that the drug has been shown to prevent the decline of kidney function in patients with CKD.
The researchers found that lubiprostone increases spermidine production, which improves mitochondrial function by promoting bacterial growth in the gut. The improvement in spermicide production is protective and suppresses further kidney damage.
Potential Concerns
Diarrhea can lead to dehydration, which can be harmful to damaged kidneys. This is due to the electrolyte balance that is often caused by using laxatives. However, though some participants experienced abdominal cramping, diarrhea, and dizziness, none experienced any significant changes to their electrolytes.
Also, quite a few CKD patients were excluded from the trial. That includes patients who had kidney transplants, are on immunosuppressant drugs or other types of laxatives, and those who are diagnosed with drug-induced kidney injury or acute RF.
The research group was led by Professor Takaaki Abe of Tohoku University Graduate School of Medicine.
“We noticed that constipation is a symptom that often accompanies CKD, and decided to investigate this link further,” explains Abe. “Essentially, constipation disrupts the intestinal microbiota, which worsens kidney function. Working backwards, we hypothesized that we could improve kidney function by treating constipation.”
Lubiprostone shows promise in becoming a prescribed treatment to help slow down the damage to the kidneys for those with CKD.
