Constipation May Increase Risk of Death in CKD and Heart Failure: Meta-Analysis Reveals
China: A new meta-analysis published in Annals of Medicine suggests that constipation may be associated with an increased risk of all-cause mortality, particularly among individuals with chronic health conditions such as chronic kidney disease (CKD) and heart failure. Interestingly, no clear link was observed between constipation and cardiovascular-specific mortality, highlighting the need for further research to clarify its prognostic role.
The study was conducted by Dr. Bing Liu and colleagues from the Department of Anorectal Surgery, The First Affiliated Hospital of China Medical University, Shenyang, China. The researchers systematically reviewed longitudinal observational studies examining the relationship between constipation and mortality outcomes. A total of 13 studies, reported across 14 articles and including over 3.7 million participants, were analyzed to determine pooled hazard ratios (HRs) for all-cause and cardiovascular mortality.
Key Findings:
- Constipation was associated with a 10% increased risk of all-cause mortality in the general population.
- In patients with chronic kidney disease, constipation was linked to a 40% higher risk of all-cause mortality (HR 1.40).
- Individuals with heart failure had an 85% higher risk of all-cause mortality associated with constipation (HR 1.85).
- No significant association was observed between constipation and cardiovascular mortality in the general population (HR 1.19).
- Constipation was not significantly linked to cardiovascular mortality among CKD patients (HR 1.33).
- The findings suggest that increased all-cause mortality may be driven by factors related to chronic disease rather than direct cardiovascular effects.
The study’s findings highlight the importance of recognizing constipation as a potential marker for poorer outcomes in patients with chronic illnesses. The authors suggest that routine assessment of bowel health could provide additional insight into overall patient risk and may help identify individuals who might benefit from more intensive monitoring or intervention.
However, the authors caution that the results should be interpreted in light of several limitations. The included studies were observational, limiting the ability to establish causality. Definitions and assessments of constipation varied across studies, which could influence the pooled risk estimates. Residual confounding factors such as diet, physical activity, and medication use may also have affected the results. Additionally, most CKD participants were dialysis patients, which may not reflect the broader CKD population, and language restrictions could have excluded relevant research published in non-English sources.
Despite these limitations, the meta-analysis provides compelling evidence that constipation is independently associated with increased all-cause mortality, especially in chronic disease populations. The researchers recommend standardizing constipation assessment and validating these findings across diverse cohorts to better understand its prognostic significance.
"While constipation does not appear to significantly impact cardiovascular-specific mortality, it may serve as an important indicator of overall health risk, particularly in patients with chronic kidney disease or heart failure. Further studies are needed to explore underlying mechanisms and to determine whether targeted interventions for constipation could improve long-term outcomes in these vulnerable populations," the authors concluded.
Reference:
Liu, B., Wu, X., Wang, Y., & Hu, X. (2025). Association between constipation and risk of cardiovascular or all-cause mortality: a meta-analysis. Annals of Medicine, 57(1). https://doi.org/10.1080/07853890.2025.2561803
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