Korean J Med.  2019 Aug;94(4):362-370. 10.3904/kjm.2019.94.4.362.

The Colonoscopic Characteristics and Clinical Manifestations Associated with Lower Gastrointestinal Tract Bleeding in Patients with Chronic Kidney Disease

• Lee KJ
• Koo HS
• Kim YS
• Min JH
• Jo SY
• Yoon WE
• Lee DH
• Kim JY
• Moon JS
• Koh HI

• KMID: 2454680
• DOI: http://doi.org/10.3904/kjm.2019.94.4.362

Abstract

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.

MeSH Terms

Anticoagulants
Blood Platelets
Colonoscopy
Female
Gastrointestinal Tract
Glomerular Filtration Rate
Hemorrhage*
Hemorrhoids
Humans
Incidence
Logistic Models
Lower Gastrointestinal Tract*
Renal Dialysis
Renal Insufficiency, Chronic*
Retrospective Studies
Ulcer
Uremia
Anticoagulants