Patients with end-stage renal disease were at an increased risk of hospitalization for acute diverticulitis

Chang, Shen Shong; Huang, Nicole; Hu, Hsiao Yun

doi:10.1097/md.0000000000004881

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Regarding drugs, the potential protective effect of calcium channel blockers in reducing the rate of diverticular complications observed in case-control analyses 37 , 47 needs to be confirmed. Also, the recent epidemiological evidence that reports a higher prevalence of AD among women older than 50 years of age 11 , 48 , younger individuals 5 , 11 , 13 , and patients with end-stage renal disease 49 , as well as the association of cardiovascular disease and chronic obstructive pulmonary disease with complicated DD 28 , 50 , needs to be confirmed and explained.…”

Section: Risk Factors For Acute Diverticulitis and Relative Recurrencmentioning

confidence: 98%

Recent advances in understanding and managing diverticulitis

Severi

Carabotti²,

Cicenia

et al. 2018

F1000Res

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In the past few decades, the increasing socioeconomic burden of acute diverticulitis (AD) has become evident, and with the growth of the population age, this significant economic impact will likely continue to rise. Furthermore, recent evidence showed an increased rate of hospital admissions especially evident among women and younger individuals. The natural history and pathophysiology of this clinical condition is still to be fully defined, and efforts continue to be made in the identification of risk factors and the establishment of relative preventive strategies. The actual therapeutic strategies aimed to modulate gut microbiota, such as rifaximin or probiotics, or to reduce mucosal inflammation, such as mesalazine, present a relatively poor efficacy for both the prevention of the first AD episode (primary prevention) and its recurrence (secondary prevention). In the last few years, the main goal achieved has been in the management of AD in that uncomplicated AD can, to a larger extent, be managed in an outpatient setting with no or little supportive therapy, a strategy that will certainly impact on the health costs of this disease. The problem of AD recurrence remains a topic of debate. The aim of this review is to present updated evidence on AD epidemiology and relative open clinical questions and to analyze in detail predisposing and protective factors with an attempt to integrate their possible modes of action into the several pathogenic mechanisms that have been suggested to contribute to this multifactorial disease. A unifying hypothesis dealing with the colonic luminal and extra-luminal microenvironments separately is provided. Finally, evidence-based changes in therapeutic management will be summarized. Because of an ascertained multifactorial pathogenesis of uncomplicated and complicated AD, it is probable that a single ‘causa prima’ will not be identifiable, and a better stratification of patients could allow one to pursue tailored therapeutic algorithm strategies.

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Section: Risk Factors For Acute Diverticulitis and Relative Recurrencmentioning

confidence: 98%

Recent advances in understanding and managing diverticulitis

Severi

Carabotti²,

Cicenia

et al. 2018

F1000Res

View full text Add to dashboard Cite

show abstract

“…This is also consistent with results of previous reports. Chang et al reported that patients with ESRD has higher incidence of acute colonic diverticulitis, higher rates of surgical interventions and mortality [ 20 ]. Morris et al studied the incidence of perforated diverticulitis and risk factors for death in a UK population.…”

Section: Discussionmentioning

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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“…Patienten mit verschiedenen Nierenerkrankungen im Endstadium unter Dialysebehandlung (n = 32 000) hatten eine eindrucksvoll höhere kumulative Inzidenz für eine akute Divertikulitis als gematschte Kontrollen. Das Risiko war nach Adaptation an alle möglichen Risikofaktoren um den Faktor 11,2 größer [112].…”

Section: Arterielle Hypertonieunclassified

“…Multimorbidität ist als ein gesonderter Risikofaktor von erheblicher Bedeutung zu werten. Arbeiten über den Charlson Komorbiditäts Index (> 3) als Risikoindikator bei der Divertikelkrankheit geben davon Zeugnis [112]. Eine weitere Publikation bestätigt nicht nur den prädiktiven Wert des Charlson Index für die Schwere einer Divertikulitis sondern auch die des American Society of Anesthesiologists (ASA) Physical Status Classification Scores (ASA) [131].…”

Section: Multimorbiditätunclassified