Constipation is a very frequent complaint in patients undergoing dialysis patients. A study was conducted to evaluate the safety and effectiveness of polyethylene glycol 3350+ electrolytes (PEG 3350 +E) over a period of 10 weeks in hemodialysis patients with constipation. This case series included seven patients. The study was conducted in three phases: Pre-intervention or baseline (2 weeks), intervention period (6 weeks) and post-intervention period (2 weeks)

During the pre-intervention periods, patients were allowed to take laxatives, including stimulant laxatives, which they had used prior to their participation in the present study. In the first week of the intervention period, patients were given PEG3350+E one sachet per day. They could take an extra sachet each week for the remainder of the intervention period, up to a maximum of six sachets daily in the final week. The amount of PEG 3350+E was adjusted in order to reduce stimulant laxatives and increase spontaneous bowel movements. The amounts of PEG3350+E and stimulant laxatives were fixed during the post-intervention period. 

A marked reduction (25.8% of the baseline) in the amount of stimulant laxatives used was reported after use of PEG3350+E. There was a significant increase in the ratio of spontaneous bowel movements (SBMs) i.e. bowel movements without the need for a laxative and complete SBMs to total BMs. An improvement in bowel movements with ideal stool consistency was seen after the intervention.

A significant observation was that four out of the seven patients did not require stimulant laxatives; three patients took stimulant laxatives but in a much reduced amount (partial responders). This means that patients could reduce their dependence on stimulant laxatives. The net result was an improvement in the quality of life in terms of constipation as evident by lowering of the Japanese version of the Patient Assessment of Constipation Quality of Life Questionnaire (JPAC-QOL) score. 

Although systolic blood pressure, body weight gain, serum sodium, potassium and albumin levels did not alter much with PEG 3350 + E, s. However, significant increase in the diastolic BP was noted post-intervention. Only one patient required an increase in dose of lanthanum carbonate for hyperphosphatemia. Lanthanum carbonate is known to cause constipation. The study authors speculate that this may have been the reason for the resistant response to PEG 3350+ E. 

Therefore, PEG 3350+E is a safe and effective option for the treatment of constipation in patients undergoing hemodialysis. It can reduce the need for stimulant laxatives and increase spontaneous bowel movements and complete spontaneous bowel movements associated with a feeling of complete evacuation. Although no serious adverse effects on the body fluid retention or blood pressure were noted, nevertheless one should be careful about fluid accumulation and excessive body weight gain when administering PEG3350+E to hemodialysis patient. They should be carefully monitored.