The safety of polyethylene glycol plus ascorbic acid has not been fully investigated in patients with renal insufficiency, peg with ascorbic acid. High-dose ascorbic acid could induce hyperoxaluria, thereby causing tubule-interstitial nephritis and renal failure. This study aims to evaluate the safety and peg with ascorbic acid 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: 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.
The 2 L polyethylene glycol plus ascorbic acid solution is a safe choice for bowel preparation before colonoscopy in patients with impaired renal function. Adequate bowel preparation is essential for both diagnostic evaluation and therapeutic procedures performed using colonoscopy. Although various agents are used for bowel cleansing, the safety and efficiency of these agents have always been important issues. A split method of administering 4 L PEG before the day and on the day is usually prescribed for colonoscopy.
However, a high-volume of PEG solution is poorly tolerated; its distasteful flavor and high volume are disadvantages for its intake. Electrolyte changes after using PEG or PEG-Asc have been investigated and no differences in bowel preparation quality or side effects have been observed. However, whether the use of high-dose ascorbic acid could increase the risk of renal disease or specific electrolyte imbalance remains unclear.
We performed a retrospective analysis of the demographic, endoscopic, and laboratory data of the patients who underwent colonoscopy between January and December at our hospital. Individual cases where no timely data before or after colonoscopy were available were excluded. Patients with combined severe co-morbidity, peg with ascorbic acid, acute infection, or acute renal failure without CKD were also excluded. From the peg with ascorbic acid patients, we reviewed the results of blood biochemistry analysis before and after colonoscopy.
And we reviewed the reports on bowel cleansing quality as observed by endoscopy according to the Boston bowel preparation scale. We compared the differences in bowel preparation quality, demographic data, and contractor affirmative action plan findings between the PEG and PEG-Asc groups.
Data are presented as the mean value and standard deviation or as proportions. Data were analyzed using the Statistical Package for the Social Sciences version Among these patients, only the patients whose timely results of blood tests were available were enrolled this study, peg with ascorbic acid.
No significant decrease in the levels of serum sodium, potassium, chloride, CO 2calcium, magnesium, or phosphate was observed. A mild increase in the mean values of blood urea nitrogen BUN and creatinine was observed after bowel preparation using both, PEG and PEG-Asc; however, the increase was not statistically significant.
The risk of creatinine increase was not significantly different between the 2 groups. There was no permanent worsening of renal function after bowel cleaning.
All patients who underwent colonoscopy were asked to answer a questionnaire. The proportion of patients who experienced moderate to severe abdominal discomfort was significantly higher in the PEG group than in the PEG-Asc group. Based on the 4-point Boston Bowel Preparation Scale, there was no difference in the peg with ascorbic acid of preparation of each portion of the colon between the 2 groups. Colonoscopy is an effective procedure for detecting colorectal diseases and for cancer screening.
Bowel cleansing before colonoscopy is an important process for adequate examination; therefore, endoscopists have been concerned about optimal and safe bowel preparation, peg with ascorbic acid. Renal insufficiency associated with CKD is a significant risk factor for electrolyte imbalance. Acute phosphate nephropathy could be induced by the impaired clearance of the sodium phosphate.
Prior investigators reported that low-volume PEG demonstrate noninferiority compared to high-volume PEG for bowel cleansing. Low-volume PEG-Asc was developed to improve patient acceptability, and some studies have shown it to be an equally efficient and tolerable alternative to high-volume PEG.
According to prior case reports and studies, peg with ascorbic acid, high-dose ascorbic acid could induce tubule-interstitial nephritis with hyperoxaluria or progressive renal failure. Although some investigators have studied the safety of bowel-cleansing agents in special conditions, [ 3132 ] to our knowledge, a comparative study between PEG and PEG-Asc in patients with CKD has not been conducted.
Although the mean absolute values of BUN and creatinine were increased after bowel cleansing, the change was not significant. As the average serum value peg with ascorbic acid venous CO 2 was stable, there was no fear of metabolic acidosis after bowel cleansing due to the use of high-dose ascorbic acid. Additionally, minor serum electrolytes such as calcium did not show a significant increase or decrease in patients with CKD.
Successful bowel cleansing was mostly observed with use of both preparations; they were generally well tolerated. The fewer complaints of abdominal discomfort in the PEG-Asc group could be partly attributed to the low volume of the agent. Whereas several previous studies have reported inferior results with the use of low-volume PEG for bowel cleansing, [ 33 — 35 ] there was no significant difference in the bowel cleansing quality in our study.
This study has some major limitations. First, it focused on the safety of PEG-Asc in patients with CKD, and adenoma detection rates or diagnostic accuracy was noted recorded. Second, peg with ascorbic acid, several independent factors such as peg with ascorbic acid in the patients as well as chronic health conditions were not considered.
Moreover, the scoring of quality of bowel preparation was subjective, and there was a lack of randomization for bowel cleansing agents due to retrospective design. However, there has been no study to evaluate the safety of using ascorbic acid along with a bowel-cleansing agent in patients with decreased renal function. To our knowledge, this is the first study to evaluate electrolyte changes after the administration of PEG with high-dose ascorbic acid in patients with stage 3 to 5 CKD.
In cases of decreased renal function, it could be used for bowel preparation before colonoscopy. The inclusion of ascorbic acid in the PEG-Asc solution did not increase the risk of electrolyte imbalance or renal failure. The authors have no conflicts of interest to disclose.
National Center for Biotechnology Informationpeg with ascorbic acid, U. Journal List Medicine Baltimore v, peg with ascorbic acid. Published online Sep 9. Find articles by Myung Gyu Kim, peg with ascorbic acid. Find articles by Sang Kyung Jo. Published by Wolters Kluwer Health, Inc. The work cannot be changed in any way or used commercially.
This article has been cited by other articles in PMC, peg with ascorbic acid. Abstract The safety of polyethylene glycol plus ascorbic acid has not been fully investigated in patients with renal insufficiency. Introduction Adequate bowel preparation is essential for both diagnostic evaluation and therapeutic procedures performed using colonoscopy. Study design We performed a retrospective analysis of the demographic, endoscopic, and laboratory data of the patients who underwent colonoscopy between January and December at our hospital.
Efficacy and safety From the selected patients, we reviewed the results of blood biochemistry analysis before and after colonoscopy. Statistical analysis Data are presented as the mean value and standard deviation or as proportions. Table 1 Characteristics of patients with CRF who underwent colonoscopy. Open in a separate window.
Table 2 Comparison of laboratory values before and after agent intake. Quality of bowel preparation and patient tolerance All patients who underwent colonoscopy were asked to answer a questionnaire. Table 4 Outcomes of bowel preparation and quality of cleansing. Discussion Colonoscopy is an effective procedure for detecting colorectal diseases and for cancer screening.
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