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More Evidence that Sodium Phosphate Causes Renal Failure

Summary and Comment |
August 14, 2014

More Evidence that Sodium Phosphate Causes Renal Failure

  1. Douglas K. Rex, MD

It should not be routinely used as a bowel preparation for colonoscopy.

  1. Douglas K. Rex, MD

The use of oral sodium phosphate as a bowel preparation for colonoscopy has decreased dramatically in the U.S. because of reports of renal failure caused by calcium phosphate deposition in the renal tubules. Renal failure related to sodium phosphate is assumed to be rare, but the actual magnitude of the risk remains uncertain.

In this population-based, case-crossover study from Korea, researchers identified 47,782 patients aged ≥50 years who were hospitalized with acute renal failure between 2006 and 2009. Of these patients, 1105 had undergone colonoscopy after a sodium phosphate prescription and had no recorded perforations or prescriptions for polyethylene glycol solution.

At time windows of 1, 2, 4, 8, and 12 weeks after oral sodium phosphate exposure, the adjusted odds ratio for acute renal failure in exposed patients was 3.7, 3.5, 3.0, 2.4, and 2.0, respectively, all of which were statistically significant. Sodium phosphate use was associated with renal failure in patients aged <65 years as well as ≥65 years and in patients without specific comorbidities.

Comment

This study provides additional evidence that sodium phosphate should not be used routinely as a bowel preparation for colonoscopy.

  • Disclosures for Douglas K. Rex, MD at time of publication Consultant / Advisory board Given Imaging; Olympus Corporation America; Exact Sciences; Endo Aid Speaker’s bureau Boston Scientific; Braintree Laboratories; Ferring Pharmaceuticals; Olympus America Grant / Research support CDC; Olympus America; Boston Medical Center Editorial boards World Journal of Gastroenterology; The Journal of Clinical Gastroenterology; Techniques in Gastrointestinal Endoscopy; Gastroenterology & Hepatology; Expert Review of Gastroenterology & Hepatology; Medscape Gastroenterology; World Journal of Gastrointestinal Pharmacology and Therapeutics; Annals of Gastroenterology & Hepatology; World Journal of Gastrointestinal Oncology; Comparative Effectiveness Research; Journal of Anesthesia & Clinical Research; Gastroenterology; World Journal of Gastrointestinal Pathophysiology; Gastroenterology Research and Practice; GI & Hepatology News; Gastroenterology Report; Clinical Epidemiology Reviews; JSM Gastroenterology and Hepatology Leadership positions in professional societies American Society for Gastrointestinal Endoscopy (Councilor); US Multi-Society Task Forces (AGA, ACG, ASGE) (Chair)

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