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    Michael L. Aaronson, MD
    Kidney Doctor and High Blood Pressure Specialist
    7401 O Street Lincoln, NE 68510
    Phone: 402-484-5600

    Saturday, April 27, 2019

    Kidney Disease and Constipation. What is Your Best Option?

    Use the cap as a measuring cup.

    Constipation can be a major problem for many people whether they have chronic kidney disease or not. Many bowel remedies have on their labels a request that patients ask their doctors for permission prior to use.

    Some medications for slow bowels have been shown to cause kidney failure requiring renal replacement therapy or dialysis. If you have kidney disease and are constipated, you need to make sure your approach to treating constipation is not affecting the body's electrolytes or risking kidney injury.

    Sidebar: acute phosphate nephropathy or acute kidney injury can be caused by enemas containing sodium phosphate. Avoid these products if you have kidney disease. If an enema is going to be considered, you might want to try a warm water enema instead.

    So what should you do if you fall into this category and prefer a less invasive approach? In other words, you want to avoid the enemas!

    I would suggest Miralax or its equivalent. Consider the following options:

    • Miralax, 
    • Equate ClearLax, 
    • Basic Care ClearLax Polyethylene Glyclol, 
    • Member's Mark ClearLAX,
    • Others

    A bottle costs between $12.92-$23-94. If you purchase a three pack, you will spend less per serving.

    Branded Miralax. The effective, active ingredient in the product is polyethylene glycol. Choose the cheapest polyethylene glycol product available to you. They are all effective.

    The active ingredient in the product is polyethylene glycol. The medicine can be purchased over the counter. It works as an osmotic laxative (so it is not absorbed). It dissolves in any beverage -- including coffee -- that's a pearl). There is no grit. Not much fluid is required for it to dissolve. The therapy is safe for the kidneys.

    It's like magic! You saw the powder in the cap above.... Now you don't! Figure shows Miralax dissolved in water. However, any liquid will work including coffee or your protein drink.
    I would suggest Miralax over Metamucil fiber supplements because you are less likely to have flatulence.

    Any of the Miralax equivalents will work. So consider choosing the cheapest available.

    Assuming you are caught up on your health maintenance, including colonoscopies, making colon cancer as a cause for constipation less likely, many people can use Miralax daily and safely. That strategy is an effective one, as long as you get approval from your doctor.

    Learn more about Dr. Michael Aaronson.

    What should you do if Miralax does not work? Sometimes a medication called lactulose can be considered. Another therapy that does not require dosage adjustment and is safe in patients with  kidney impairment is called Linzess or linaclotide. There are other options as well.

    That said, most patients with constipation and chronic renal failure are able to tolerate Miralax without problems. If you start getting diarrhea or the stools are too soft, consider decreasing the daily amount ingested. In other words, instead of a full capful daily, decrease the daily dose to half a capful. If that is too much, try taking "some" every Monday, Wednesday, and Friday. This is not rocket science. Tailor the dose to effect.

    Need to remember to take your medicine? [Read more: How Do I Remember to Take My Pills Correctly?]

    In conclusion, constipation can be treated. Patients with chronic kidney disease should not have to suffer. Consider polyethylene glycol as a modality to help keep you regular after consulting with your physician.