Not Again!

In one of those little flukes during which I didn’t receive my nephrologist’s report until a few weeks after the doctor visit and didn’t catch everything he said during the visit (yes, even after almost three years), I noticed a colonoscopy was recommended.  But I had one only eight years ago! When I called the nephrologist’s office to speak to his M.A. in an effort to find out why I needed this test, it was explained to me that the fatigue I’d been experiencing just might be from polyps.

That didn’t sound right to me so I dutifully made an appointment with the gastroenterologist, and while there, had a long, involved discussion with him.  He wisely allowed me to do most of the talking to see if he could get a handle on the nephrologist’s reason for wanting this test performed, but couldn’t.

Was it my failure to understand the M.A.?  Could be, but just to be certain AND to find out which drugs I would be allowed since I now have CKD  and was going to be “put out” – oh, Lord, I hope that’s nothing akin to being “put down” – for the experience , this specialist agreed to call the other specialist.

Here it is almost two weeks later and I’ve heard nothing from either of them.  Apparently, my nephrologist is on vacation and we’re waiting for his return. So, of course, I started researching on my own.  I still can’t quite figure out why I’m having the test since I couldn’t find anything about polyps contributing to fatigue in CKD patients (which doesn’t mean the information isn’t there – it may have been too technical for me to understand), but I did discover the following warning on the National Kidney Foundation’s site:

Oral Sodium Phosphate Safety Alerts

Patients with chronic kidney disease (CKD) who use bowel cleansing products should be aware of a recent warning issued by the FDA for a type of sudden loss of kidney function or acute kidney injury, as well as, blood mineral disturbances. Phosphate crystal deposition in the kidneys causes the loss of kidney function, which can lead to kidney failure. The medical term for this condition is acute phosphate nephropathy.

The warning relates to the use of bowel cleansing agents, called sodium phosphate (OSP) products as laxatives or in preparation for colonoscopy. OSPs are available both with and without a prescription and are taken by mouth. These products can cause phosphate nephropathy.

Oral sodium phosphates clear the bowel by making bowel movements frequent, loose and runny. These agents work by causing fluid loss so it is recommended to patients that they drink large quantities of clear liquids as part of the bowel preparation.
Symptoms of acute phosphate nephropathy are:

  • Lethargy
  • Drowsiness
  • Decreased urination
  • Swelling of ankles, feet and legs

Early on, people may not have any symptoms at all. Anyone at high risk for this condition should have their kidney function monitored by their doctor.

Visicol® and OsmoPrep® are available by prescription only. Other similar OSP products are non-prescription, and can be used as a laxative at low doses.

Children under 18 years should not use these products alone or in combination with other laxatives containing sodium phosphate. Others groups who are at risk for acute phosphate nephropathy are:

  • People over 55
  • CKD patients
  • People who are dehydrated
  • People who have bowel obstruction, delayed bowel emptying or active colitis
  • People taking medications such as diuretics, angiotensin converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], and inflammation and pain relief medications such as nonsteroidal anti-inflammatory drugs [NSAIDs])

The FDA requested that the manufacturer of Visicol® and OsmoPrep®, Salix Pharmaceuticals;

  • Add a black boxed warning to the pharmacy package insert for these products
  • Develop and distribute a medication guide for patients that is easier for most patients to understand than package inserts
  • Arrange a post-marketing trial to assess the risks to patients taking OSP products

Non-prescription OSP products have a long history of safety when used as laxatives and will still be available over the counter. However, because of the recent warning by the FDA, those OSP products should only be used as laxatives and not for bowel cleansing. The FDA suggests consumers should get a prescription from a health care professional when thinking about having a bowel cleansing.

The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer with one of several tests, including colonoscopy. If your doctor recommends colonoscopy, concerns about bowel cleansing should not prevent you from undergoing colon cancer screening. Colon cancer is treatable when the disease is caught early and the best treatment is to identify and remove precancerous polyps before they progress to cancer.

A high-quality and safe colon cleansing preparation is important for colon cancer screening using colonoscopy. There are other FDA-approved alternatives to OSP for bowel preparation prior to colonoscopy that may be safer for some patients, but may not always clean the bowel adequately. Patients should discuss the risks of the preparation and procedure, versus the benefits of the screening to determine the best bowel cleaning agent for their age, and risk conditions noted above.
More than 26 million American adults and thousands of American children have Chronic Kidney Disease. Most do not know they have this condition.

Date Reviewed: July 2009″

July, 2009, was 18 months ago yet I’ve found no updates anywhere on the internet.  Whether or not I’m satisfied with what my nephrologist tells the gastroenterologist or what the gastroenterologist tells me, I intend to bring this information with me to the gastroenterologist BEFORE the procedure and certainly bring it to the attention of the nephrologist.  After all, I am responsible for managing my own health issues.

Until Tuesday,

Keep living your life.

Published in: on February 18, 2011 at 9:59 am  Comments (6)  

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6 CommentsLeave a comment

  1. In spite of the ability to exchange medical information electronically, physicians fail to do this frequently.
    Understanding ones health issues,monitoring them with
    due diligence is vital. I totally agree with the author of this article. I am about to cancel a colonoscopy,
    at least until I can find a suitable colon cleanser. 4th
    stage CKD and taking Zemplar, in my case,has now become a toss-up. Acute renal failure vs.colon cancer. As a 77
    year old woman,3 years post a colonoscopy, I’m taking
    my chances, but there you are…….

    • I wish I could offer you help of any kind, Gloria, but know nothing about stage 4 CKD. I hope being able to write about your situation helped ease the stress just a bit. To be honest, sometimes I wonder if we’re just incidental to our physicians. You know: see the patient, write the notes, file the patient away with the chart until next visit. I hope I’m wrong.

  2. Gail,
    I may be off centre with this web site, but your reply was , nevertheless, encouraging – to the extent that there is someone out there with my views on the matter.

    • Thanks, Gloria. You know my good wishes are with you. My book ( being printed as we type) is only about the early stages. I guess I’ll have to write a sequel when I move on to the latter stages of CKD.

      • Thank you, once again. I will be on the look out for your book. Please give me a heads up
        when it is available.
        I wish you well with the inevitable progression of CKD. With the right food, low
        blood pressure, regular check ups you should be able to keep the next stage at bay for a very long time.
        Chin up, Gail.

      • I’ll announce the book on the blog as soon as it’s ready for the public. Au contraire, thank YOU for your encouraging comments. It’s back to editing for me now.

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