Patients with chronic kidney disease (CKD) and anemia have a high prevalence of gastrointestinal (GI) lesions, according to a new study.

The study is the first to examine the relationship between anemia in patients with CKD and GI lesions, according to a team led  by Rebeca García Agudo, MD, of La Mancha-Centro Hospital, Alcazar de San Juan, Cuidad Real, and the University of Seville in Spain.

Dr Agudo and her colleagues conducted a cross-sectional observational study of 286 with both CKD and anemia. Of these 198 had a positive fecal occult blood test (FOBT). Endoscopic studies revealed 255 lesions, with at least 1 lesion found in 68.2% of patients, the investigators reported online ahead of print in Nefrologia. The most prevalent lesions were adenomatous colorectal polyps (39.6%), acute gastric mucosa lesions (22.6%), neoplastic lesions (15.1%), and angiodysplasias (14.4%).

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Uremia (urea level above 50 mg/dL) and aspirin use were associated with a 7.7- and 2.8-fold increased risk of acute gastric mucosa lesions, respectively.

Enolism was associated with a 7.8-fold higher risk of angiodysplasias. Patients with CKD stages 4–5 had a 2.4 times higher risk of angiodysplasias compared with patients with CKD stage 3. Hemoglobin levels below 11 g/dL and hyporesponsiveness to erythropoiesis-stimulating agents were associated with a 2.9- and 10-fold increased risk of angiodysplasias, respectively.

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Age and refractory anemia were risk factors adenomatous polyps and colorectal cancer.

Study strengths include its prospective design, sample size, inclusion of diverse patients with a wide range of age and estimated glomerular filtration rate, as well as the collection of detailed demographic and clinical data and use of gastroscopy and complete colonoscopy to evaluate patients with a positive FOBT. With regard to study limitations, the authors noted that patients who have advanced CKD or on dialysis have a high prevalence of mucosal inflammation and trivial lesions in the upper GI tract. These can result in bleeding and a positive FOBT in the absence of clinically important lesions and lead to overuse of colonoscopy, the investigators noted.


García Agudo R, Aoufi Rabih S, González Carro P, et al. Gastrointestinal lesions in chronic kidney disease patients with anaemia. Nefrologia. 2018; published online ahead of print.