Acute renal failure following oral sodium phosphate bowel preparation: a nationwide case-crossover study.
OBJECTIVE
Oral sodium phosphate (OSP) is a cleansing agent for colonoscopy. Recent reports have cited an increased risk of acute renal failure (ARF) in OSP bowel purgative users, but this risk remains under debate. This study was performed to evaluate the association between OSP and ARF in patients who underwent colonoscopy.


METHODS
A population-based case-crossover study was conducted using the Korean Health Insurance Review and Assessment Service (HIRA) claims data from 1 January 2005 to 31 December 2009. The study population consisted of patients aged ≥ 50 years who underwent colonoscopies after an OSP prescription prior to their first hospitalization for ARF. For each patient, one hazard and four control periods were matched at specified time windows. Conditional logistic regression analysis was used to estimate the odds ratio (OR) and 95 % confidence interval (CI), adjusting for concomitant medications that could induce ARF.


RESULTS
A total of 1105 patients were included (54 % male). The adjusted ORs for ARF related to the use of OSP when applying the 1-, 2-, 4-, 8-, or 12-week time windows were 3.7 (95 %CI 2.37 - 5.67), 3.5 (95 %CI 2.45 - 4.89), 3.0 (95 %CI 2.30 - 3.95), 2.4 (95 %CI 1.93 - 2.96), and 2.0 (95 %CI 1.69 - 2.46), respectively. When adopting an 8-week time window, the adjusted OR was 2.5 (95 %CI 1.98 - 3.16) for the subgroup without chronic renal failure.


CONCLUSIONS
The use of OSP was significantly associated with ARF both in patients with and without co-morbidities.
Medical Research Collaborating Center, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea.
Nam-Kyong
NK
Choi
Medical Research Collaborating Center, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea.
Joongyub
J
Lee
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Yoosoo
Y
Chang
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
Ye-Jee
YJ
Kim
Department of Family Medicine, Health Promotion Center, Seoul National University Bundang Hospital, Bundang, Korea.
Ju-Young
JY
Kim
Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Korea.
Hong Ji
HJ
Song
Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
Ju-Young
JY
Shin
Korea Institute of Drug Safety and Risk Management, Seoul, Korea.
Sun-Young
SY
Jung
Department of Internal Medicine, Hyewon St. Mary's Hospital, Gumi, Korea.
Yukyong
Y
Choi
Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Korea.
Jin-Ho
JH
Lee
Medical Research Collaborating Center, Seoul National University Hospital/Seoul National University College of Medicine, Seoul, Korea.
Byung-Joo
BJ
Park
D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology; D000369:Aged, 80 and over; D002400:Cathartics / Q000009:adverse effects*; D003113:Colonoscopy; D018592:Cross-Over Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000009:adverse effects*; D056910:Republic of Korea / Q000453:epidemiology
D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate