Kidney Week

Abstract: FR-PO1125

Lubiprostone Use and Kidney Outcomes in Patients with CKD and Constipation: A Large, Nationwide, Observational Study of US Veterans

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Keiichi Sumida, MD, PhD, MPH, FASN

• Mallisetty, Yamini, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Yamini Mallisetty, MSc, MPH

• Khan, Rida Nusrat, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Rida Nusrat Khan

• Shrestha, Prabin, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Prabin Shrestha, PhD

• Thomas, Fridtjof, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Fridtjof Thomas, PhD

• Kalantar-Zadeh, Kamyar, Harbor-UCLA Medical Center Department of Internal Medicine, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States

Csaba P. Kovesdy, MD, FASN

Background

Lubiprostone, a chloride channel activator, has been shown to exert renoprotective effects by improving the gut microbiota in animal studies. Little is known about the association of lubiprostone use with kidney outcomes in patients with CKD.

Methods

In a nationwide cohort of 86,157 US veterans with an eGFR <60 mL/min/1.73m² and constipation receiving care from the VA healthcare system over 2004-2019, we examined the association of incident chronic use of lubiprostone (de-novo prescription with ≥30-day supply) with subsequent risk of a composite kidney outcome (incident ESKD, incident eGFR <15 mL/min/1.73m², or 57% reduction in eGFR), using multivariable Cox models and propensity score (PS)-overlap weighted analysis accounting for sociodemographics, comorbidities, vital signs, eGFR, and relevant medications. Untreated patients were enrolled on a randomly assigned date based on the start dates in the treated group to mitigate differential start of follow-up bias.

Results

Patients were 73±10 years old; 96% were male; 16% were African American; and 86% were diabetic. Their baseline eGFR was 49±9 mL/min/1.73m². Among 86,157 patients, 945 (1.1%) started lubiprostone therapy. After multivariable adjustment, incident use (vs. non-use) of lubiprostone was significantly associated with a lower risk of a composite kidney outcome (adjusted HR [95% CI], 0.66 [0.55-0.78]). A similar association was observed in the PS-overlap weighted analysis (0.71 [0.59-0.85]) (Table).

Conclusion

Incident use (vs. non-use) of lubiprostone is independently associated with a lower risk of kidney outcomes in patients with CKD and constipation.

Funding

• Veterans Affairs Support