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KMID : 0882420190940040362
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Korean Journal of Medicine
2019 Volume.94 No. 4 p.362 ~ p.370
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The Colonoscopic Characteristics and Clinical Manifestations Associated with Lower Gastrointestinal Tract Bleeding in Patients with Chronic Kidney Disease
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Lee Kyun-Jin
Koo Ho-Seok
Kim You-Sun
Min Jeong-Wha
Jo Soo-Yeon
Yoon Won-Eui
Lee Dong-Hoon
Kim Jin-Young
Moon Jeong-Seop
Koh Haeng-Il
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Abstract
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Background/Aims: Patients with chronic kidney disease (CKD) have a high risk of gastrointestinal tract bleeding because of platelet dysfunction attributable to uremia, a poor blood supply, and frequent use of anticoagulant agents. We describe the colonoscopic characteristics of lower gastrointestinal tract bleeding (LGIB) in patients with CKD.
Methods: A total of 230 hospitalized patients with CKD who underwent colonoscopy because of suspected LGIB between January 2003 and August 2016 were reviewed retrospectively. We categorized CKD into five stages according to the estimated glomerular filtration rate and compared the colonoscopic findings and clinical manifestations among these five subgroups.
Results: Of the 230 patients with CKD suspected of LGIB, 73 (31.7%, 103 cases) were colonoscopically confirmed to exhibit LGIB. Their mean age was 65.7 ± 12.8 years, and 52.1% were female (n = 38). The most common causes of LGIB were hemorrhoidal bleeding (32 cases, 43.8%), followed by bleeding of colorectal ulcers (21 cases, 28.8%), diverticular bleeding (12 cases, 16.4%), colitis-related bleeding (12 cases, 16.4%), and angiodysplastic bleeding (12 cases, 16.4%). As the CKD stage progressed, the incidence of LGIB increased (p = 0.043). On multivariate logistic regression analysis, LGIB was more common in CKD patients with hemorrhoids (odds ratio [OR]: 4.349, 95% confidence interval [CI]: 2.043-9.256, p < 0.001) or colorectal ulcers (OR: 20.001, 95% CI: 4.780-83.686, p < 0.001) and in those on hemodialysis (OR: 6.863, 95% CI: 1.140-41.308, p = 0.035).
Conclusions: In CKD patients, the risk of LGIB is significantly increased by hemorrhoids, colorectal ulcers, and a positive hemodialysis status.
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KEYWORD
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Colonoscopy, Renal insufficiency, Chronic, Gastrointestinal hemorrhage
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