Colon‐Cancer Screening in Dialysis Patients

Abstract

The usefulness of colon‐cancer screening using stool‐guaiac testing has been established in large control populations, but not in dialysis patients. In 72 asymptomatic dialysis patients [51 treated with hemodialysis (HD), and 21 with peritoneal dialysis (PD)] who underwent outpatient stool occult blood testing, the test result was positive in 11 (15%) patients (8 HD and 3 PD). Eight of the 11 were investigated further by colonoscopy and, when deemed necessary by the treating physician, esophago‐gastroduodenoscopy and/or barium enema were also performed. A site of active bleeding was identified in three of the eight patients (hemorrhoids, telangiectasia, ulcerative colitis). In each of the five other patients, potentially bleeding lesions were identified: colonic polyps (two malignant and two benign) in four patients, Barrett's esophagus in one, diverticulosis in two, and colonic vascular deformities in two. These results were compared with those of a large ongoing fecal occult blood screening program in which the prevalence of positive stool occult blood tests is 5% and in which 42% of the positive patients have colonic neoplasms. Thus, although the baseline incidence of positive guaiac tests may be higher in dialysis patients than in nonuremic controls, our results suggest that stool guaiac testing of dialysis patients may not only be useful in detecting colonic polyps, but may also identify other previously unsuspected causes of gastrointestinal bleeding.

Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis

“…We could not obtain information on the endoscopists' experience, specialty/credential-the circumstances in which perforations occurred. The CCI may also not be enough to capture all the comorbidities of the included patients [18]. Furthermore, perforations that result from incomplete colonoscopies or sigmoidoscopies and colonoscopies billed as sigmoidoscopies would not be included in our study, which would have altered or underestimated the perforation rate.…”

“…These therapeutic maneuvers increase the risk of adverse events during colonoscopy. HD patients have a high risk for lower gastrointestinal bleeding from cancer or vascular abnormalities which also require colonoscopy [17,18]. A recent single center, case-control study of patients undergoing both diagnostic and therapeutic colonoscopy from Japan reported a high incidence of perforation during colonoscopy in ESRD patients on HD [19].…”

Comparison of Stage at Diagnosis of Cancer in Patients Who Are on Dialysis versus the General Population

“…Uremic platelet dysfunction combined with anticoagulation given during hemodialysis results in a bleeding diathesis that may bring gastrointestinal lesions to attention earlier (27). For instance, dialysis patients are more likely to have positive stool guaiac tests than nonuremic control subjects (28). Finally, diagnostic evaluations for gastrointestinal diseases that are especially common in dialysis patients, such as angiodysplasia or constipation, may lead to incidental identification of malignant lesions (29).…”

Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

“…The specificity of screening for colon cancer among patients with ESRD differs from the general population because dialysis patients have a high incidence of nonmalignant gastrointestinal bleeding abnormalities making guaiac testing misleading. In one study, the incidence of guaiac positive stools was three times higher in asymptomatic dialysis patients compared to non-ESRD controls [56]. …”