Does 2 L Polyethylene Glycol Plus Ascorbic Acid Increase the Risk of Renal Impairment Compared to 4 L Polyethylene Glycol?
The use of polyethylene glycol (PEG)-based solutions is the gold standard for bowel preparation. However, PEG use might be associated with the risk of acute kidney injury.



We aimed to compare the safety of 2 L PEG plus ascorbic acid (AA) versus 4 L PEG.



Health examinees that underwent colonoscopy and blood tests on the same day at our center were included in this retrospective study. All subjects were prescribed either 2 L PEG plus AA or 4 L PEG for the bowel preparation prior to the colonoscopy. The incidences of electrolyte imbalance and renal impairment after colonic preparation were investigated. Renal impairment was determined if the subject's estimated glomerular filtration rate was measured less than 60 mL/min/1.73 m2.



Of the 29,789 cases, 14,790 received 2 L PEG plus AA (group A) and 14,999 received 4 L PEG (group B) for colonic preparation. Renal impairment occurred more commonly in group A (n = 467, 3.2 %) than in group B (n = 189, 1.3 %). Electrolyte changes such as hypernatremia and hyperkalemia were more common in group A than group B, whereas hyponatremia, hypokalemia, and hypophosphatemia were more common in group B than group A. Old age, male sex, and the use of 2 L PEG plus AA were independent risk factors for renal impairment.



The evidence strongly suggests that acute kidney injury is more likely to occur when 2 L PEG plus AA is used for the bowel preparation than when 4 L PEG is used.



KCT0001703.
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Sang Pyo
SP
Lee
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Eugene
E
Park
School of Medicine, The University of Melbourne, Melbourne, Australia.
Han Viet
HV
Kim
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea. inksung@kuh.ac.kr.
In-Kyung
0000-0002-3848-5571
IK
Sung
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Jeong Hwan
JH
Kim
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Sun-Young
SY
Lee
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Hyung Seok
HS
Park
Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 143-729, Korea.
Chan Sup
CS
Shim
D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000328:Adult; D000367:Age Factors; D001205:Ascorbic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D002400:Cathartics / Q000008:administration & dosage / Q000009:adverse effects*; D003113:Colonoscopy / Q000379:methods; D003404:Creatinine; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced / Q000453:epidemiology; D006955:Hypernatremia / Q000139:chemically induced / Q000453:epidemiology; D017674:Hypophosphatemia / Q000139:chemically induced / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014883:Water-Electrolyte Imbalance / Q000139:chemically induced* / Q000453:epidemiology
D002400:Cathartics; D011092:Polyethylene Glycols; D003404:Creatinine; D001205:Ascorbic Acid
Bowel preparation; Colonoscopy; Polyethylene glycol; Renal impairment