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Published on: April 12, 2021
Discrepancy between self-perceived mycophenolic acid-associated diarrhea and stool water content after kidney
Rianne M Douwes1, J Casper Swarte1, Adrian Post1
1Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Background:
Diarrhea is a well-known side effect of mycophenolic acid (MPA) use in kidney transplant recipients (KTRs). It is unknown whether self-reported diarrhea using the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) corresponds to stool water content and how both relate to MPA usage.
Methods:
MTSOSD-59R questionnaires filled out by 700 KTRs from the TransplantLines Biobank and Cohort Study (NCT03272841) were analyzed and compared with stool water content. Stool samples (N = 345) were freeze-dried, and a water content ≥80% was considered diarrhea.
Results:
Self-perceived diarrhea was reported by 46%, while stool water content ≥80% was present in 23% of KTRs. MPA use was not associated with self-perceived diarrhea (odds ratio(OR) 1.32; 95% confidence interval(CI), 0.87-1.99, p = .2), while it was associated with stool water content ≥80% (OR 2.88; 95%CI, 1.41-5.89, p = .004), independent of potential confounders. Adjustment for prior MPA discontinuation because of severe diarrhea, uncovered an association between MPA use and self-perceived diarrhea (OR 1.80; 95%CI, 1.13-2.89, p = .01).
Conclusions:
These results suggest that reporting bias could add to the discrepancy between both methods for diarrhea assessment. We recommend use of objective biomarkers or more extensive questionnaires which assess information on stool frequency and stool consistency, to investigate post-transplantation diarrhea.
Insights
Diarrhea in kidney transplant recipients is often self-reported but objective stool analysis reveals a different prevalence. Mycophenolic acid use is linked to objective diarrhea, not self-reported symptoms, suggesting reporting bias.
Area of Science:
- Nephrology
- Transplantation Immunology
- Clinical Pharmacology
Background:
- Diarrhea is a common side effect of mycophenolic acid (MPA) in kidney transplant recipients (KTRs).
- The correlation between self-reported diarrhea (using the Modified Transplant Symptom Occurrence and Symptom Distress Scale - MTSOSD-59R) and objective stool water content in KTRs remains unclear.
- Understanding this relationship is crucial for managing MPA-related gastrointestinal complications.
Purpose of the Study:
- To investigate the concordance between self-reported diarrhea and objectively measured stool water content in KTRs.
- To determine the association between mycophenolic acid (MPA) usage and both self-reported and objectively measured diarrhea.
- To identify potential factors influencing the discrepancy between subjective and objective diarrhea assessment.
Main Methods:
- Analysis of MTSOSD-59R questionnaires from 700 KTRs in the TransplantLines Biobank and Cohort Study.
- Comparison of self-reported diarrhea with stool water content analysis from 345 KTRs.
- Stool samples were freeze-dried, with ≥80% water content defined as diarrhea.
Main Results:
- Self-perceived diarrhea was reported by 46% of KTRs, whereas objective diarrhea (stool water ≥80%) was found in 23%.
- MPA use was not significantly associated with self-reported diarrhea (OR 1.32) but was linked to objective diarrhea (OR 2.88, p=0.004).
- After adjusting for prior MPA discontinuation due to severe diarrhea, MPA use became associated with self-reported diarrhea (OR 1.80, p=0.01).
Conclusions:
- A discrepancy exists between self-reported diarrhea and objective stool water content in KTRs, potentially due to reporting bias.
- MPA is associated with objective stool water content, suggesting it is a direct cause of diarrhea.
- Objective biomarkers or detailed questionnaires assessing stool frequency and consistency are recommended for accurate post-transplantation diarrhea assessment.
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