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Association of Oral Sodium Phosphate Purgative Use with Acute Kidney Injury

Frank P. Hurst^*, Erin M. Bohen^*, Eric M. Osgard, David K. Oliver^*, Nealanjon P. Das^*, Sam W. Gao^* and Kevin C. Abbott^*

^* Nephrology Service and Gastroenterology Service, Walter Reed Army Medical Center, Washington, DC, and Uniformed Services University of the Health Sciences, Bethesda, Maryland

Correspondence: Dr. Frank P. Hurst, US Army, Walter Reed Army Medical Center, Washington, DC 20307. Phone: 202-782-6462; Fax: 202-782-0185; E-mail: frank.hurst{at}us.army.mil

Received for publication March 22, 2007. Accepted for publication August 10, 2007.

Oral sodium phosphate (OSP) is a commonly used purgative before colonoscopy. There have been numerous reports of acute phosphate nephropathy attributed to the use of OSP. This study evaluated the association between the use of OSP and acute kidney injury (AKI) in an observational, retrospective, cohort study. Of 9799 patients who underwent colonoscopy and had serum creatinine values recorded within 365 days before and after the procedure, AKI, defined as 50% increase in baseline serum creatinine, was identified in 114 (1.16%). After adjustment for significant covariates in a multiple logistic regression model, the use of OSP was associated with increased risk for AKI (odds ratio 2.35; 95% confidence interval 1.51 to 3.66; P < 0.001) with an adjusted number need to harm of 81. Age was also independently associated with AKI in this cohort; therefore, until larger, prospective studies define the population at risk for acute phosphate nephropathy, the use of polyethylene glycol-based purgatives should be considered for older patients and possibly for those with comorbid medical conditions.

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