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A Systematic Review of Renal Impairment and Use of Oral Sodium Phosphate as a Bowel Cleanser
Table 3 continued
Author/Year/ Country Renal Injury Death Dose of OSP CRF Age Sex HTN/DM ACE ARB Diuretics
Reference
Khurana, 2006
100
US Yes No NR No 72 F HTN Yes No Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN Yes No Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN No Yes Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN No Yes Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN No Yes Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN No No Yes
Khurana, 2006
100
US Yes No NR No 72 F HTN No No No
Khurana, 2006
100
US Yes No NR No 72 F HTN No No No
Khurana, 2006
100
US Yes No NR No 72 F HTN No No No
Khurana, 2006
100
US Yes No NR No 72 F DM No No No
Khurana, 2006
100
US Yes No NR No 72 M DM No No No
Kuehn, 2008
101
US No No Oral 45ml x 2 No 23 M No No No NR
Larson, 1986
102
US No No 10–30ml No 0.5 M No No No No
Markowitz, 2004
20
US Yes NR NR No 69 M HTN No Yes No
Markowitz, 2004
20
US Yes NR NR No 82 M HTN No No No
Markowitz, 2004
20
US Yes NR NR No 55 F HTN/DM No Yes Yes
Markowitz, 2004
20
US Yes NR NR No 64 F HTN/DM Yes No Yes
Markowitz, 2004
20
US Yes NR NR No 76 F HTN No Yes No
Markowitz, 2005
22
US Yes NR No No 44 M HTN No No No
Markowitz, 2005
22
US Yes NR NR No 53 M HTN No Yes No
Markowitz, 2005
22
US Yes NR NR No 81 F No No No No
Markowitz, 2005
22
US Yes NR NR No 82 F HTN No Yes Yes
Markowitz, 2005
22
US Yes NR NR No 57 F HTN Yes Yes No
Markowitz, 2005
22
US Yes NR NR No 76 F HTN No Yes No
Markowitz, 2005
22
US Yes NR NR No 74 F HTN No No No
Markowitz, 2005
22
US Yes NR NR No 57 F No No No No
Markowitz, 2005
22
US Yes NR NR No 43 F HTN/DM Yes No Yes
Markowitz, 2005
22
US Yes NR NR No 39 F No No No No
Markowitz, 2005
22
US Yes NR NR No 69 F HTN Yes No No
Markowitz, 2005
22
US Yes NR NR No 66 F HTN/DM Yes No No
Markowitz, 2005
22
US Yes NR NR No 51 F HTN Yes Yes Yes
Markowitz, 2005
22
US Yes NR NR No 79 F No Yes Yes Yes
Markowitz, 2005
22
US Yes NR NR No 44 M HTN Yes Yes Yes
Markowitz, 2005
22
US Yes NR NR No 62 F No Yes Yes Yes
Markowitz, 2005
22
US Yes NR NR No 64 F HTN Yes Yes Yes
Mishra, 2005
103
US No No Oral 45ml x 2 Yes 51 F No NR NR NR
Mishra, 2005
103
US No No Oral 45ml x 2 Yes 57 M DM NR NR NR
Orias, 1999
104
US Yes No 2 bottles No 76 M HTN No No No
Rocuts, 2008
105
US Yes No NR No 60 F HTN/DM Yes No Yes
Ullah, 2002
106
US Yes NR 90ml Yes 55 M HTN/DM No No No
Vukasin, 1997
107
US No No 90ml x 2 No 69 F No No No No
Zipser, 1975
108
US No No Oral 180ml No 41 M No No No No
NR = not reported; HTN = hypertension; DM = diabetes; CRF = chronic renal failure; ACE-I = angiotensin-converting enzyme inhibitor; ARB = angiotensin receptor blocker.
changes in creatinine or GFR according to the studies by Brunelli et The inconclusive and mixed results of the epidemiological studies are
al.
58
and Russman et al.,
60
and the study of Abaskharoun et al.,
11
with influenced by several methodological considerations. There were
only two of 618 patients with pre-existing chronic renal disease. The particular shortcomings with the analysis by Khurana et al.,
57
who
one study where all patients had pre-existing renal disease (GFR used controls from two sources. One source consisted of patients not
<60ml/min) found an incontrovertible and significant increase in undergoing colonoscopy at any time and the second group of
risk of acute renal injury with OSP use compared with use of PEG. controls were patients undergoing colonoscopies before 1996 and
This finding is consistent with renal impairment being a clear having creatinine values that did not increase after the procedure.
contraindication for OSP use in the product label. No clear risk This would produce a highly biased comparison of clean patients.
factors were identified that increased the risk of renal damage Also, many (85%) of the eligible patients were excluded, resulting in
following OSP exposure, except for pre-existing renal impairment. highly questionable generalisability of the findings. Finally, the
One study that excluded patients with GFR <60ml/min found an statistical analysis did not indicate old age as a risk factor, but it was
increased risk. Risk factors that have been (inconsistently) cited as a risk factor in the text.
proposed from these studies include old age, female gender,
low GRF, high blood pressure, heart failure and use of diuretics, The study by Brunelli
58
found that that exposure to OSP was no
ACE-I and ARBs. more common among patients with incident kidney injury than in
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