Constipation is one of the most prevalent conditions in primary care settings and increases the risk of cardiovascular disease, potentially through processesmediated by altered gutmicrobiota. However, little is known about the association of constipationwithCKD. In a nationwide cohort of 3,504,732United States veterans with an eGFR $60 ml/min per 1.73 m2, we examined the association of constipation status and severity (absent, mild, ormoderate/severe), defined using diagnostic codes and laxative use,with incident CKD, incident ESRD, and change in eGFR in Cox models (for time-to-event analyses) and multinomial logistic regression models (for change in eGFR). Among patients, the mean (SD) age was 60.0 (14.1) years old; 93.2% of patients were men, and 24.7% were diabetic. After multivariable adjustments, compared with patients without constipation, patients with constipation had higher incidence rates of CKD (hazard ratio, 1.13; 95% confidence interval [95% CI], 1.11 to 1.14) and ESRD (hazard ratio, 1.09; 95% CI, 1.01 to 1.18) and faster eGFR decline (multinomial odds ratios for eGFR slope<-10<-10 to<-5, and-5 to<-1 versus -1 to <0 ml/min per 1.73m2 per year, 1.17; 95% CI, 1.14 to 1.20; 1.07; 95% CI, 1.04 to 1.09; and 1.01; 95%CI, 1.00 to 1.03, respectively).More severe constipation associatedwith an incrementally higher risk for each renal outcome. In conclusion, constipation status and severity associate with higher risk of incident CKD and ESRD and with progressive eGFR decline, independent of known risk factors. Further studies should elucidate the underlying mechanisms.
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