Selecting Appropriate Pharmacological Maintenance of Bowel Function in the Hemodialysis Patient
Abstract The hemodialysis patient frequently experiences deviation from normal bowel function that may require pharmacological intervention. Constipation is commonly encountered in this population. The most desirable laxative for a dialysis patient would be one that accounts for fluid restriction, use of phosphate-binding agents, dietary and electrolyte restrictions, and toxicity. Laxatives are classified as bulk forming, emollient, lubricant, saline, stimulant, and hyperosmotic. Bulk laxatives are recommended for initial treatment of constipation and may be used long term. However, the main disadvantage of the use of these products in the dialysis population is the required concomitant ingestion of water. Laxatives intended for short-term use are routinely abused. Acute use of these agents (ideally an emollient laxative) can provide effective therapy and avoid problems associated with long-term use. Diarrhea occurs less frequently and may be treated with a variety of agents. Polycarbophil, also considered a bulk laxative, can be used effectively for the treatment of diarrhea in this population.