Lower Gastrointestinal Bleeding in Chronic Hemodialysis Patients

Abstract

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.

Chronic Kidney Disease and Risk for Gastrointestinal Bleeding in the Community: The Atherosclerosis Risk in Communities (ARIC) Study

“…Although underlying pathophysiology is quite different between upper and lower GI bleeding (25-28), we observed consistent associations of CKD measures across sites of GI bleeding. In patients with ESRD, accumulation of uremic toxins impairs platelet aggregation and normal platelet-vessel interactions (29), increasing bleeding risk (30). Furthermore, high prevalence of gastric vascular ectasia (31) and ischemic colitis (32) among individuals with CKD may also contribute to the higher risk.…”

Occult gastrointestinal bleeding is a common finding in dogs with chronic kidney disease

“…Furthermore, these alterations are secondary to vascular lesions including diffuse antral vascular ectasia and angioectasia associated with intermittent requirement of anticoagulation therapy . Gastrointestinal bleeding observed in hemodialysis patients may not be entirely attributable to their underlying renal disease due to the plethora of drugs in standard treatments of such patients, such as heparin, antiplatelet agents, and anticoagulants that could contribute to increased bleeding tendency in human ESRD patients …”

The Use of Castor Oil for Bowel Preparation for Colon Capsule Endoscopy

“…However, the capsule excretion rate after recommended bowel preparation reportedly ranges from 70% to 90%, and administration of boosters is also necessary. For dialysis patients [2] [3], liquid loading is a problem [4]- [9]. At my hospital, the capsule excretion rate after recommended bowel preparation was 53.3% in dialysis patients.…”