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Kidney failure colonoscopy prep is the bowel prep for a patient with kidney failure. There are different stages of chronic kidney disease. The most advanced stage is stage 5 in which the patient rely on dialysis to live. Patients with kidney failure can have colonoscopy.
What is kidney failure?
Kidney failure is the most serious form of kidney disease in which a person cannot live without dialysis or kidney transplant. There are 2 types of dialysis-hemodialysis and peritoneal dialysis.
What are the stages of kidney failure
The stages are based on estimated glomerular filtration rate or eGFR.
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1 with normal or high eGFR (eGFR > 90 mL/min)
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2 Mild kidney disease (eGFR = 60-89 mL/min)
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3A Moderate kidney disease (eGFR = 45-59 mL/min)
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3B Moderate kidney disease (eGFR = 30-44 mL/min)
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4 Severe kidney disease (eGFR = 15-29 mL/min)
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5 End Stage kidney disease (eGFR <15 mL/min). People with stage 5 kidney failure need dialysis to live.
Who should not be prepped for colonoscopy
- Patients with hypersensitivity to any of the ingredients of the the bowel cleansing agent.
- Those with a gastrointestinal obstruction that will prevent passage of liquid into the intestine.
- Patients with an ileus.
- Unconscious patients. In some instances, bowel cleansing agent can be given through a nasogastric tube.
- Inability to swallow. In certain cases, bowel cleansing agent can be given through a nasogastric tube.
- Patients with toxic colitis or toxic megacolon.
Common side effects of bowel prep
- Nausea.
- Abdominal distention.
- Dehydration.
- Abdominal cramps.
- Lightheadedness.
- Dizziness.
- Abnormal electrolytes like low potassium, low sodium, low magnesium and low chloride. These can cause seizures.
Which bowel cleansing agents should be avoided by people with kidney disease?
Oral sodium phosphate should be avoided in patients with chronic kidney disease. Patients with chronic kidney disease are more likely to develop acute phosphate nephropathy after using oral sodium phosphate.
In 2006, the US Food and Drug Administration (FDA) issued a warning regarding oral sodium phosphate use in high risk patients. These patients include those with kidney disease, liver disease, heart failure, high blood calcium, and elderly patients over the age of 55. It also include patients taking certain medications like NSAIDS, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and diuretics.
In 2008, another warning was issued by the FDA. It required a black box warning for oral sodium phosphate drugs like Visicol and Osmoprep. Osmoprep appears to be better tolerated than Visicol. Also, the FDA warned against the use of Fleet Phospho Soda for bowel cleansing prior to colonoscopy.
Polyethylene glycol (PEG) based bowel cleansing agents such as Golytely, Nulytely, Trilyte, and Colyte are preferred in patients with chronic kidney disease. Manufacturers advised caution with use of Suprep, Clenpiq and Prepopik in patients with kidney disease.
All bowel cleansing agents have the potential to cause kidney failure because of diarrhea and changes in electrolytes. Having kidney disease does not mean you should not stay hydrated.
How to do kidney failure colonoscopy prep
- Choose a PEG-based bowel cleansing.
- Take the bowel cleansing agent using the split dose bowel prep regimen.
- Do not schedule colonoscopy on the same day as your dialysis.
- If you are on peritoneal dialysis, antibiotics may be needed before your colonoscopy.
Suggested Reading
- How to tell if your bowel is clean prior to colonoscopy.
- Diabetes and colonoscopy. How to take your medications before colonoscopy.
- 30 myths about bowel prep, colonoscopy, and colorectal cancer.
