# The efficacy of Cassia fistula on constipation in chronic kidney disease patients in comparison with lactulose: A randomized clinical trial

## TL;DR

This study found that Cassia fistula syrup is more effective than lactulose for treating constipation in chronic kidney disease patients.

## Contribution

This is the first trial to evaluate Cassia fistula syrup for constipation in CKD patients and assess its impact on lab factors.

## Key findings

- Cassia fistula syrup improved defecation frequency more than lactulose in CKD patients.
- CFS reduced straining, lumpy stools, and stool hardness compared to lactulose.
- CFS led to significant decreases in blood urea nitrogen and creatinine levels.

## Abstract

Chronic constipation (CC) is common in chronic kidney disease (CKD) patients. This study was performed to evaluate the efficacy of Cassia fistula syrup (CFS) on CC in CKD patients.

This randomized clinical trial was conducted on CKD patients with CC referred to nephrology clinics of Babol University of Medical Sciences in 2022-23.They were examined by a nephrologist and 66 patients were randomly allocated into two groups, receiving CFS or lactulose, with the same dosage (30 ml/day) for 2 weeks. Patients were visited in the 1st, 2nd and 3rd weeks to evaluate clinical characteristics according to ROME IV criteria, quality of life (PAC-QOL), and laboratory factor levels. Data were analyzed by SPSS25 using intention to treat viewpoint and by applying the ANCOVA, Repeated measure analysis, T-test and Chi-square test.

In the CFS group, defecation frequency per week and daily (primary outcome) improved significantly compared to the lactulose group (p-Value=0.01).

As secondary outcomes, the percent of straining, lumpy stools and stool hardness in the CFS group was significantly better than the lactulose (p <0.05). In the CFS group, blood urea nitrogen (BUN) (p-Value=0.045) and creatinine (Cr) (p =0.01) decreased after the intervention significantly. PAC-QOL showed significant improvements in subscales and total scores in the CFS group compared to the lactulose group (p<0.001).

This is the first trial that evaluated CFS on CC in CKD patients, and monitored the changes in laboratory factors levels. CFS demonstrates greater efficacy than lactulose in managing CC among CKD patients. PAC-QOL was greatly better in CFS group rather than lactulose group.