Prevalence of Cholelithiasis in Non-Diabetic Haemodialysis and Continuous Ambulatory Peritoneal Dialysis Patients

Abstract

Haemodialyzed (HD) patients have been found to have an increased bile cholesterol level and an increased saturation index in bile. These changes were markedly enhanced in the presence of a low-protein diet. To evaluate whether such changes influence the prevalence of cholelithiasis in patients with end-stage renal failure, real-time sonography was performed to detect the presence of gallstones (GS) in 54 HD (28 males, 26 females, mean age 52.4 ± 15.4 years) and 39 continuous ambulatory peritoneal dialysis (CAPD; 22 males, 17 females, mean age 59.1 ± 14.9 years) patients. No patient had diabetes. The patients’ charts were reviewed for the following data: age, sex, primary renal disease, obesity (20% above ideal weight), history suggestive of gallbladder disease or previous cholecystectomy, duration of dialysis, and serum cholesterol levels. Overall, cholelithiasis was documented in 12 of 93 (12.9%) patients, 7 HD and 5 CAPD. When comparing the factors outlined above, no significant difference was found between HD and CAPD patient groups, either with or without cholelithiasis. Gallbladder disease was asymptomatic in all except 1 patient who required cholecystectomy. Using a healthy control group consisting of local age- and sex-matched inhabitants, GS were found in 8 of 134 (6%) of them (p > 0.05). We conclude that the prevalence rate of GS in our dialysis population (HD and CAPD) is similar to that of a local general population following a western-style diet, irrespective of dialysis mode.

The Risk of Gallbladder Stone Formation Is Increased in Patients with Predialysis Chronic Kidney Disease but Not Those Undergoing Chronic Hemodialysis Therapy

“…2). Many previous studies have also reported that GBS prevalence is not significantly correlated with hemodialysis duration [4,7,8,9,10, 12], while we could find no conflicting reports (table 4). Thus, being under hemodialysis therapy does not appear to be a risk factor for the formation of new GBS.…”

“…There are several previous reports that have shown that the prevalence of GBS is comparable between end-stage CKD patients and a control group [4,5,6,7,8,9]. Ethnicity is a possible explanation for the differences between the study results.…”

“…It remains unclear whether or not the prevalence of GBS is higher in patients with stage 5 CKD (CKD5) [4,5,6,7,8,9,10,11,12,13]. Thus, we performed an observational clinical study in which patients with CKD, including those in predialysis stages, were included as subjects.…”

Increased frequency of gallbladder stone and related parameters in hemodialysis patients

“…Numerous studies revealed an increased prevalence of biliary lithiasis in hemodialysis (HD) patients compared to the healthy population (2,3). However, others reported similar incidences with normal populations (4,(6)(7)(8)(9). Besides the risk of complications, patients on dialysis treatment with asymptomatic GBS would have more severe complications related to GBS after transplantation (10).…”

Higher Incidence of Cholelithiasis in Chronic Renal Failure Patients with Secondary Hyperparathyroidism Undergoing Peritoneal Dialysis

“…[16,17] In some studies, some of which were controlled, the incidence of gallbladder stones (GBS) in CRF patients undergoing hemodialysis (HD) was found to be similar to that in controls. [18][19][20][21] However, according to uncontrolled reports, hemodialysis has been found to increase the risk of gallstone formation secondary to increased biliary cholesterol and biliary saturation index; the incidence in dialysis patients increases by as much as 30%. [22,23] It has been reported that HD patients have increased bile saturation.…”