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

Navaneethan, Udayakumar; Parasa, Sravanthi; Venkatesh, Preethi G.K.; Shen, Bo

doi:10.1007/s00384-011-1400-8

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…Our results highlight the importance of colon cancer screening in kidney transplant candidates, by demonstrating a higher risk of colonic adenomas in patients with ESKD on HD. While screening colonoscopy is often deferred in patients with ESKD on HD because of comorbidities and concerns about higher rates of colonoscopy‐related complications, our study did not find a higher risk of complications in ESKD on HD, undergoing screening colonoscopy as compared to controls .…”

Section: Discussioncontrasting

confidence: 68%

“…Demographics, including age, race, gender, were forced into the model. Other variables selected a priori , including BMI and DM, were also included in the model given suggested associations with risk of developing colorectal cancer . We selected additional variables for inclusion in the final model using backward stepwise selection model building with cutoff for inclusion in the model of alpha <0.1.…”

Section: Methodsmentioning

confidence: 99%

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High prevalence of colon adenomas in end‐stage kidney disease patients on hemodialysis undergoing renal transplant evaluation

Saumoy

Jesudian

Aden

et al. 2016

Clinical Transplantation

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The aim of this study was to determine whether patients with end-stage kidney disease (ESKD) on hemodialysis (HD) undergoing kidney transplant evaluation are at higher risk for colonic neoplasia than the general population. This is a retrospective cohort study of patients with ESKD who underwent a first screening colonoscopy while undergoing kidney transplant evaluation. Data were collected on the prevalence of adenomatous polyps and advanced adenomas in 70 patients with ESKD and 70 controls, undergoing their first screening colonoscopy, matched for age, gender, and endoscopist. At the time of the colonoscopy, an average time on HD was 3.2 ± 2.9 yr. The prevalence of adenomatous polyps was significantly higher in ESKD on HD (54.3% vs. 32.9%, p = 0.008) than in controls. In a multivariate analysis controlling for other factors, ESKD on HD remained a risk factor for the presence of adenomas (OR 3.06, 95% CI 1.21, 7.73). No colonoscopy-related complications were reported in the patients with ESKD on HD. We demonstrate a significantly higher prevalence of adenomatous polyps in patients with ESKD undergoing a first screening colonoscopy as part of kidney transplant evaluation. In addition, colonoscopy can be safely performed in this population.

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Section: Discussioncontrasting

confidence: 68%

Section: Methodsmentioning

confidence: 99%

High prevalence of colon adenomas in end‐stage kidney disease patients on hemodialysis undergoing renal transplant evaluation

Saumoy

Jesudian

Aden

et al. 2016

Clinical Transplantation

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“…Our observations were also consistent with a recent study from Japan, which substantiated a higher incidence of polypectomy perforation that occurred in patients with ESRD on hemodialysis compared with non‐ESRD groups (0.45% vs 0.02%; OR, 21.17; 95% CI, 5.05–88.73; P < 0.0001) . The authors suggested that gastrointestinal amyloidosis was probably part of the reason for the decreased elasticity of the intestinal membrane and hence the increased risk of perforation …”

Section: Discussionsupporting

confidence: 92%

“…In contrast, a nationwide, population‐based study reported from Udayakumar et al . has shown that risk of colonic perforation following diagnostic colonoscopy was not increased in ESRD inpatients . The higher risk of perforation in patients with ESRD in our study was probably because of the exclusion of surveillance colonoscopies in contrast to Udayakumar et al .…”

Section: Discussioncontrasting

confidence: 65%

Incidence and risk factors of colonoscopic post‐polypectomy bleeding and perforation in patients with end‐stage renal disease

Yang

Tai

et al. 2020

J of Gastro and Hepatol

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Background and Aims: Colonoscopic polypectomy in end-stage renal disease (ESRD) patients are at risks of post-polypectomy bleeding and perforation, but evidences are limited. This study aimed to determine the incident polypectomy complications among ESRD patients. Methods: In the nationwide ESRD cohort, a propensity score matched case-control study design was conducted to assess risk associated with post-polypectomy bleeding and perforation using the Taiwanese National Health Insurance Research Database from 1997 to 2013 for adults aged 40 years and older; 7011 ESRD and 19 118 non-ESRD patients met the study criteria. A total of 5302 patients in each group were matched for further analyses. The primary endpoint was post-polypectomy bleeding or bowel perforation in 30 days. The secondary endpoint was mortality and length of hospital stay for the bleeding complications requiring hospitalization. Results: Overall incidences of post-polypectomy bleeding or perforation in patients with ESRD was higher than the non-ESRD group (5.83% vs 1.78%, P < 0.0001) in the matched cohort. High risk of adverse outcomes was associated with ESRD (adjusted odds ratio [aOR], 2.38, 95% confidence interval [

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“…Digestive tract cancer (IR 68.9 per 10,000) was the most frequent cancer and the five most common sub-sites included the colorectum, lung, liver, stomach, and kidney. Screening for colorectal cancer using endoscopy in this clinical population is often considered to increase the risk of complications associated with the bowel cleansing preparation and with the procedure itself [18][19][20] . However, for ESKD patients with long life expectancies, colonoscopy for cancer screening should be considered with caution.…”

Section: Discussionmentioning

confidence: 99%

Epidemiological characteristics of cancers in patients with end-stage kidney disease: a Korean nationwide study

Lee

Park

et al. 2021

Sci Rep

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Patients with end-stage kidney disease (ESKD) have been reported to have an increased risk of cancer. However, the epidemiological characteristics of cancer in ESKD patients remain unclear. Therefore, this study aimed to investigate the epidemiological characteristics of cancer in ESKD patients and the differences based on the renal replacement therapy provided. Data on ESKD patients were obtained from the South Korean nationwide cohort Health Insurance Review and Assessment Service database. This study included 58,831 eligible patients of the total 813,907 patients diagnosed with ESKD between January 1, 2007 and December 31, 2017. Of the 58,831 ESKD patients, 3292 (5.6%) were newly diagnosed with cancer. The average duration between the diagnosis of ESKD and cancer was 3.3 ± 1.9 years (mean ± standard deviation), with no differences between hemodialysis, peritoneal dialysis, and kidney transplant groups. The most commonly observed cancer sites in ESKD patients were the colorectum, lung, and liver. The incidence of cancer increased progressively among patients undergoing kidney transplant, peritoneal dialysis, and hemodialysis in that order. Hemodialysis patients were found to have an increased risk of digestive tract cancer compared with kidney transplant patients (adjusted hazard ratio = 1.9; 95% confidence interval: 1.31–2.81; P < 0.001). The study findings may be a useful reference for cancer-screening guidelines.

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

Abstract: There appeared no increased risk of colonic perforation during colonoscopy among inpatients who received HD in our study. Increasing age and female patients appeared to be associated with procedure-related colonic perforation.

Cited by 7 publications

References 29 publications

High prevalence of colon adenomas in end‐stage kidney disease patients on hemodialysis undergoing renal transplant evaluation

High prevalence of colon adenomas in end‐stage kidney disease patients on hemodialysis undergoing renal transplant evaluation

Incidence and risk factors of colonoscopic post‐polypectomy bleeding and perforation in patients with end‐stage renal disease

Epidemiological characteristics of cancers in patients with end-stage kidney disease: a Korean nationwide study

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