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A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity

Background and study aims  Colonoscopy is a widely used diagnostic procedure which requires prior cleansing of the bowel. Many different bowel cleansing preparations have been developed, all of which have specific advantages and disadvantages. This review compares two low-volume high-osmolarity bowe...

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Autores principales: Moulin, Bruno, Ponchon, Thierry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: © Georg Thieme Verlag KG 2018
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175689/
https://www.ncbi.nlm.nih.gov/pubmed/30302378
http://dx.doi.org/10.1055/a-0581-8723
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author Moulin, Bruno
Ponchon, Thierry
author_facet Moulin, Bruno
Ponchon, Thierry
author_sort Moulin, Bruno
collection PubMed
description Background and study aims  Colonoscopy is a widely used diagnostic procedure which requires prior cleansing of the bowel. Many different bowel cleansing preparations have been developed, all of which have specific advantages and disadvantages. This review compares two low-volume high-osmolarity bowel cleansing preparations, oral phosphate salts and oral sulphate salts, with a particular focus on risk of nephrotoxicity. Patients and methods  An electronic search of the Medline database was performed using the search terms “(phosphates OR sulfates) AND cathartics [MeSH Term] AND kidney” restricted to humans with a cut-off date of December 31, 2016. Results  Introduction of oral phosphate salts offered the advantage of low intake volume and low risk of bowel irritation compared to previous options. However, phosphate salts have been associated with renal toxicity (acute phosphate nephropathy [APN]), thought to arise due to perturbations of calcium and phosphate homeostasis as a consequence of increases in serum phosphate. This results in high concentrations of calcium phosphate in the distal tubule and collecting ducts of the kidney, where it may precipitate. Although APN is rare, it may lead to permanent kidney damage. For this reason, phosphate salts are contraindicated in vulnerable patient groups. As an alternative to phosphate salts, oral sulphate salts have recently been introduced. Because sulphate absorption from the intestinal tract is saturable, serum sulphate concentrations increase only minimally after ingestion. Furthermore, excretion of sulphate in the kidney is not accompanied by calcium excretion and urine calcium levels are unchanged. For these theoretical reasons, use of sulphate salts as bowel cleansing solutions is not expected to lead to calcium precipitation in the nephron. Conclusions  Oral phosphate salts are no longer recommended for routine use as bowel cleansing preparations as they carry significant risk of kidney damage and a safer alternative is available in the form of oral sulphate solutions. To date, use of sulphate salts has not been associated with elevations in serum creatinine or other markers of renal impairment, nor with clinical manifestations of kidney injury. Nonetheless, experience with sulphate salts in everyday practice is limited and physicians should be vigilant in detecting potential safety issues.
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spelling pubmed-61756892018-10-09 A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity Moulin, Bruno Ponchon, Thierry Endosc Int Open Background and study aims  Colonoscopy is a widely used diagnostic procedure which requires prior cleansing of the bowel. Many different bowel cleansing preparations have been developed, all of which have specific advantages and disadvantages. This review compares two low-volume high-osmolarity bowel cleansing preparations, oral phosphate salts and oral sulphate salts, with a particular focus on risk of nephrotoxicity. Patients and methods  An electronic search of the Medline database was performed using the search terms “(phosphates OR sulfates) AND cathartics [MeSH Term] AND kidney” restricted to humans with a cut-off date of December 31, 2016. Results  Introduction of oral phosphate salts offered the advantage of low intake volume and low risk of bowel irritation compared to previous options. However, phosphate salts have been associated with renal toxicity (acute phosphate nephropathy [APN]), thought to arise due to perturbations of calcium and phosphate homeostasis as a consequence of increases in serum phosphate. This results in high concentrations of calcium phosphate in the distal tubule and collecting ducts of the kidney, where it may precipitate. Although APN is rare, it may lead to permanent kidney damage. For this reason, phosphate salts are contraindicated in vulnerable patient groups. As an alternative to phosphate salts, oral sulphate salts have recently been introduced. Because sulphate absorption from the intestinal tract is saturable, serum sulphate concentrations increase only minimally after ingestion. Furthermore, excretion of sulphate in the kidney is not accompanied by calcium excretion and urine calcium levels are unchanged. For these theoretical reasons, use of sulphate salts as bowel cleansing solutions is not expected to lead to calcium precipitation in the nephron. Conclusions  Oral phosphate salts are no longer recommended for routine use as bowel cleansing preparations as they carry significant risk of kidney damage and a safer alternative is available in the form of oral sulphate solutions. To date, use of sulphate salts has not been associated with elevations in serum creatinine or other markers of renal impairment, nor with clinical manifestations of kidney injury. Nonetheless, experience with sulphate salts in everyday practice is limited and physicians should be vigilant in detecting potential safety issues. © Georg Thieme Verlag KG 2018-10 2018-10-08 /pmc/articles/PMC6175689/ /pubmed/30302378 http://dx.doi.org/10.1055/a-0581-8723 Text en https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Moulin, Bruno
Ponchon, Thierry
A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title_full A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title_fullStr A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title_full_unstemmed A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title_short A comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
title_sort comparative review of use of sulphate and phosphate salts for colonoscopy preparations and their potential for nephrotoxicity
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175689/
https://www.ncbi.nlm.nih.gov/pubmed/30302378
http://dx.doi.org/10.1055/a-0581-8723
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