Constipation is one of the most common
gastrointestinal disorders among patients with
chronic kidney disease (CKD) partly because of their sedentary lifestyle, low fiber and fluid intake, concomitant medications (e.g.,
phosphate binders), and multiple comorbidities (e.g., diabetes). Although
constipation is usually perceived as a benign, often self-limited condition, recent evidence has challenged this most common perception of
constipation. The chronic symptoms of
constipation negatively affect patients' quality of life and impose a considerable social and economic burden. Furthermore, recent epidemiological studies have revealed that
constipation is independently associated with adverse clinical outcomes, such as
end-stage renal disease (
ESRD), cardiovascular (CV) disease, and mortality, potentially mediated by the alteration of gut microbiota and the increased production of fecal metabolites. Given the importance of the gut in the disposal of
uremic toxins and in
acid-base and
mineral homeostasis with declining kidney function, the presence of
constipation in CKD may limit or even preclude these ancillary gastrointestinal roles, potentially contributing to excess morbidity and mortality. With the advent of new drug classes for
constipation, some of which showing unique renoprotective properties, the adequate management of
constipation in CKD may provide additional therapeutic benefits beyond its conventional defecation control. Nevertheless, the problem of
constipation in CKD has long been underrecognized and its management strategies have scarcely been documented. This review outlines the current understanding of the diagnosis, prevalence, etiology, outcome, and treatment of
constipation in CKD, and aims to discuss its novel clinical and therapeutic implications.