Colonic diverticulitis in young patients with chronic renal failure and transplantation

Sj, Abramson; We, Berdon; Laffey, Karen J.; Ruzal-Shapiro, Carrie; Nash, Martin A.; Baer, Jeanne W.

doi:10.1007/bf02011485

Cited by 8 publications

(3 citation statements)

References 12 publications

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“…Wada et al reported that CKD was a risk factor for rebleeding in CBD (OR 2.3) [30]. Studies have also reported that diverticulosis develops at a young age in some patients with renal failure [31,32]. In patients with renal failure, the presence of uremic platelet dysfunction is considered as a cause of gastrointestinal bleeding [33].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals

Sato

Yasuda

Nakamoto

et al. 2021

J Anus Rectum Colon

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Objectives: This study aimed to examine the clinical characteristics of colonic diverticular bleeding (CDB) in elderly individuals. Methods: This retrospective case-control study was conducted at a single tertiary center. A total of 519 patients (356 men and 163 women; mean age of 73.1 ± 12.5 years) with CDB and hospitalized between January 2004 and May 2019 were analyzed. The subjects were divided into two groups: the elderly (274 individuals aged ! 75 years; mean age, 82.1 ± 5.3 years) and non-elderly (245 individuals aged <75 years; mean age, 63.0 ± 10.3 years) groups. Primary outcomes were early and late rebleeding rates, and secondary outcomes were the risk factors for late rebleeding in elderly individuals. Rebleeding occurring within 30 days of hospitalization was defined as early rebleeding, whereas rebleeding occurring after 31 days was defined as late rebleeding. Results: The early rebleeding rates were 30.6% and 33.1% (p = 0.557) in the elderly and non-elderly groups, respectively. The late rebleeding rates were 42.3% and 30.6% (p = 0.005) in the elderly and nonelderly groups, respectively. The 3-year recurrence-free survival was 63.6% in the elderly group and 75.6% in the non-elderly group (log-rank test: p < 0.001). Multivariate analysis revealed the use of non-steroidal anti-inflammatory drugs (NSAIDs) [odds ratio (OR), 3.55], chronic kidney disease (OR, 2.89), and presence of bilateral diverticula (OR, 1.83) as the independent risk factors for late rebleeding in elderly individuals. Conclusions: Elderly individuals with CDB require careful follow-up even after discharge. Furthermore, it is important to consider discontinuing NSAIDs to prevent rebleeding.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals

Sato

Yasuda

Nakamoto

et al. 2021

J Anus Rectum Colon

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“…Incidence is proportional to age with a prevalence of less than 5% at age 40 and 60–65% at the age of 80 years [28]. However, in dialysis patients with kidney disease from any cause, diverticulosis may occur at younger age and may be more severe [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

Saeed

Agrawal

Greenberg

et al. 2011

International Journal of Nephrology

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Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem.

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“…Most features of diverticular disease, including presentation, and management, are similar in those with and without renal failure. However, compared to those without renal impairment, the disease may occur at a younger age (less than 40 years) and may be more severe in patients with renal dysfunction [ 12 ]. Complications, such as perforation, are associated with a higher mortality rate, and patients may have a higher rate of bleeding resulting from iatrogenic anticoagulation and/or platelet dysfunction [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Symptomatic Diverticular Disease in Patients With Severely Reduced Kidney Function: Higher Rates of Complications and Transfusion Requirement

et al. 2017

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BackgroundThe prevalence of diverticulosis is increasing with 5-10% of patients developing diverticulitis and 5-15% developing symptomatic bleeding. Diverticulitis can result in abscess, perforation, fistula, or obstruction. Bleeding has combined morbidity and mortality rates of 10-20%. The purpose of this study was to compare diverticulitis-related complications and transfusion requirements for diverticular bleeding in patients with normal to moderately reduced kidney function (glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m2) and patients with severe renal impairment (GFR < 30 mL/min/1.73 m2), and identify factors associated with these outcomes.MethodsWe retrospectively reviewed records of all patients with diverticulitis and diverticular bleeding treated at our hospital from January 1, 2011 to July 31, 2016. Patients were evaluated for baseline characteristics, GFR, baseline hemoglobin, medications, comorbidities, length of stay (LOS), presence of perforations or abscesses and the need for transfusion.ResultsOf the 291 patients included, males were 167 (58%). Perforations and abscesses complicating diverticulitis developed in 31/136 (23%) of patients with GFR ≥ 30 mL/min/1.73 m2, and in 13/26 (50%) of patients with GFR < 30 mL/min/1.73 m2 (odds ratio (OR): 3.4; 95% confidence interval (CI): 1.423 - 8.06; P = 0.0073). Mean LOS (days) was 6.3 ± 4 in the GFR ≥ 30 mL/min/1.73 m2 group and 8.5 ± 4.4 in GFR < 30 mL/min/1.73 m2 group (P = 0.0001). Blood transfusion for diverticular bleeding occurred in 11/78 (14%) of patients with GFR ≥ 30 mL/min/1.73 m2 and in 22/51 (43%) of patients with GFR < 30 mL/min/1.73 m2 (OR: 4.6; 95% CI: 1.99 - 10.76; P = 0.0004). Among patients who needed transfusion, mean LOS was 8.5 ± 2.5 in GFR ≥ 30 mL/min/1.73 m2 group and 9 ± 5 in those with GFR < 30 mL/min/1.73 m2 (P = 0.04). There were no differences in age, gender or race between the study groups.ConclusionThere was a significant increase in complicated diverticulitis cases, transfusion requirements for diverticular bleeding and LOS in patients with severely reduced kidney function compared to patients with normal-moderately reduced renal function.

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Colonic diverticulitis in young patients with chronic renal failure and transplantation

Cited by 8 publications

References 12 publications

Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals

Risk Factors for Late Rebleeding of Colonic Diverticular Bleeding in Elderly Individuals

Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

Symptomatic Diverticular Disease in Patients With Severely Reduced Kidney Function: Higher Rates of Complications and Transfusion Requirement

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