Is it okay to do colonoscopy prep the day before the procedure using Golytely (polyethylene glycol) in a patient with a single kidney (Impaired renal function)?

Colonoscopy Prep with Golytely in a Patient with One Kidney

For patients with a single kidney, PEG-based preparations like Golytely are the preferred bowel preparation method, and can be safely administered the day before the procedure with proper hydration.

Safety of Golytely in Renal Impairment

Polyethylene glycol-electrolyte lavage solution (PEG-ELS) preparations like Golytely are considered the safest option for patients with renal impairment, including those with a single kidney. This is because:

• PEG-ELS preparations are iso-osmotic and isotonic, making them relatively safe for patients with significant comorbidities 1
• Unlike sodium phosphate preparations, PEG-ELS does not cause significant fluid and electrolyte shifts that could harm compromised kidneys 1
• The FDA label for polyethylene glycol specifically warns against use in kidney disease without medical supervision, indicating it can be used under a doctor's guidance 2

Optimal Administration Protocol

For a patient with a single kidney:

1. Preparation timing: A split-dose regimen is ideal (taking part of the preparation the evening before and the remainder on the morning of the procedure) 1

   • This provides superior bowel cleansing compared to taking the entire dose the day before
   • If morning colonoscopy is scheduled, split-dose is still preferred over day-before dosing

2. Volume considerations:

   • Standard 4L PEG-ELS provides high-quality bowel cleansing 1
   • Low-volume PEG preparations (<4L) may be considered for better tolerability but may have marginally lower cleansing efficacy 1

3. Hydration: Adequate hydration before, during, and after the preparation is crucial for patients with a single kidney to prevent dehydration

Important Precautions

• Avoid magnesium-based preparations: The guidelines specifically state that "The use of magnesium-based preparations in patients with chronic kidney disease should be avoided because of possible magnesium toxicity" 1

• Avoid sodium phosphate preparations: These are contraindicated in patients with renal insufficiency due to risk of acute phosphate nephropathy 1

• Monitor renal function: Consider checking creatinine before and after the procedure in high-risk patients 3

Common Pitfalls to Avoid

1. Using sodium phosphate preparations: Research shows these carry higher risk of renal impairment compared to PEG-ELS 3

2. Inadequate hydration: Dehydration can further compromise renal function in patients with a single kidney

3. Using magnesium citrate: Despite its common use, this should be avoided in renal impairment 1

4. Assuming all bowel preparations are equivalent: PEG-ELS is specifically recommended for patients with renal concerns 1

Some evidence suggests that lower volume PEG preparations (2L) with ascorbic acid may increase risk of renal impairment compared to standard 4L PEG 4, so the standard Golytely formulation may be preferable for patients with a single kidney.

In summary, Golytely (PEG-ELS) is the safest bowel preparation for patients with a single kidney, and can be administered the day before the procedure, though a split-dose regimen would be optimal if the procedure schedule allows.