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Diagnostic utility of immunochemical fecal occult blood tests to detect lower gastrointestinal lesions in patients with chronic kidney disease

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

The immunochemical fecal occult blood test (iFOBT) is a useful method to screen for lower gastrointestinal (GI) bleeding-related lesions. However, few studies have investigated the diagnostic utility of iFOBT in chronic kidney disease (CKD).

Methods

We included 691 patients with nondialysis-dependent CKD stages 2–5 or those receiving dialysis. Bleeding-related lower GI lesions were identified by colonoscopy, and the diagnostic utility of iFOBT was evaluated.

Results

Bleeding-related lower GI lesions were found in 9.2 % of 491 patients with CKD stage 2, 17.8 % of 107 patients with CKD stage 3/4, and 25.8 % of 93 patients with CKD stage 5/dialysis (p < 0.001). Compared with CKD stage 2, CKD stage 5/dialysis was independently associated with a 2.80-fold risk for bleeding-related lesions (p = 0.019). The iFOBT was positive in 92 (13.3 %) patients and the area under the receiver operating curve (AUC) for a bleeding-related lesion was 0.64 (p < 0.001). The sensitivity of iFOBT increased as the CKD stage worsened (20.0 vs 52.6 vs 58.3 %; p = 0.002). However, the specificity to detect bleeding-related lesions decreased with the severity of CKD stage (94.6 vs. 78.4 vs. 76.8 %; p < 0.001). The AUC of iFOBT to detect adenoma or carcinoma was 0.54 (p = 0.046), and a similar pattern of sensitivity and specificity was observed between different CKD stages.

Conclusions

The prevalence of bleeding-related lower GI lesions and the sensitivity of iFOBT to detect these GI lesions increased in advanced CKD. However, iFOBT should be used cautiously in these patients because its specificity decreased.

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References

  1. Shirazian S, Radhakrishnan J (2010) Gastrointestinal disorders and renal failure: exploring the connection. Nat Rev Nephrol 6:480–492

    Article  PubMed  Google Scholar 

  2. Wasse H, Gillen DL, Ball AM, Kestenbaum BR, Seliqer SL, Sherrard D, Stehman-Breen CO (2003) Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int 64:1455–1461

    Article  PubMed  Google Scholar 

  3. Song YM, Yoon HE, Choi YA, Kim EO, Lee SJ, Chang YK, Kim SY, Yang CW, Hwang HS (2013) Use of blood tests to predict upper gastrointestinal lesions in patients with chronic kidney disease. J Investig Med 61:1115–1120

    PubMed  Google Scholar 

  4. Wong G, Hayen A, Chapman JR, Webster AC, Wang JJ, Mitchell P, Craig JC (2009) Association of CKD and cancer risk in older people. J Am Soc Nephrol 20:1341–1350

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Wu MY, Chang TC, Chao TY, Huang MT, Lin HW (2013) Risk of colorectal cancer in chronic kidney disease: a matched cohort study based on administrative data. Ann Surg Oncol 20(12):3885–3891

    Article  PubMed  Google Scholar 

  6. Saeed F, Aqrawal N, Greenberg E, Holley JL (2011) Lower gastrointestinal bleeding in chronic hemodialysis patients. Int J Nephrol 2011:272535

    PubMed Central  PubMed  Google Scholar 

  7. Bini EJ, Kinkhabwala A, Goldfarb DS (2006) Predictive value of a positive fecal occult blood test increases as the severity of CKD worsens. Am J Kidney Dis 48:580–586

    Article  PubMed  Google Scholar 

  8. Kumaravel V, Hayden SP, Hall GS, Burke CA (2011) New fecal occult blood tests may improve adherence and mortality rates. Cleve Clin J Med 78:515–520

    Article  PubMed  Google Scholar 

  9. Viana Freitas BR, Kibune Naqasako C, Pavan CR, Silva Lorena SL, Guerrazzi F, Saddy Rodriques Coy C, Ayrizono Mde L, Mesquita MA (2013) Immunochemical fecal occult blood test for detection of advanced colonic adenomas and colorectal cancer: comparison with colonoscopy results. Gastroenterol Res Pract 2013:384561

    Article  PubMed Central  PubMed  Google Scholar 

  10. Hol L, Wilschut JA, van Ballegooijen M, Van der Valk H, Reijerink JC, Van der Toqt AC, Kuipers EJ, Habbema JD, Van Leedram ME (2009) Screening for colorectal cancer: random comparison of guaiac and immunochemical faecal occult blood testing at different cut-off levels. Br J Cancer 100:1103–1110

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Allison JE, Sakoda LC, Levin TR, Tucker JP, Tekawa IS, Cuff T, Pauly MP, Shlaqer L, Palitz AM, Zhao WK, Schwartz JS, Ransohoff DF, Selby JV (2007) Screening for colorectal neoplasms with new fecal occult blood tests: update on performance characteristics. J Natl Cancer Inst 99:1462–1470

    Article  PubMed  Google Scholar 

  12. Poggio ED, Wang X, Greene T, Van Lente F, Hall PM (2005) Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease. J Am Soc Nephrol 16:459–466

    Article  PubMed  Google Scholar 

  13. Foundation NK (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266

    Google Scholar 

  14. Rockey DC, Koch J, Cello JP, Sanders LL, McQuaid K (1998) Relative frequency of upper gastrointestinal and colonic lesions in patients with positive fecal occult-blood tests. N Engl J Med 339:153–159

    Article  CAS  PubMed  Google Scholar 

  15. Hwang HS, Song YM, Kim EO, Yoon HE, Chung SJ, Lee SJ, Chang YK, Yang CW, Chang YS, Kim SY (2012) Decisive indicator for gastrointestinal workup in anemic patients with nondialysis chronic kidney disease. Int J Med Sci 9:634–641

    Article  PubMed Central  PubMed  Google Scholar 

  16. Green BT, Rockey DC (2004) Gastrointestinal endoscopic evaluation of premenopausal women with iron deficiency anemia. J Clin Gastroenterol 38:104–109

    Article  PubMed  Google Scholar 

  17. Majid S, Salih M, Wasaya R, Jafri W (2008) Predictors of gastrointestinal lesions on endoscopy in iron deficiency anemia without gastrointestinal symptoms. BMC Gastroenterol 9:52

    Article  Google Scholar 

  18. KDOQI; National Kidney Foundation (2006) KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease. Am J Kidney Dis 47:S11–S145

    Article  Google Scholar 

  19. Babitt JL, Lin HY (2012) Mechanism of anemia in CKD. J Am Soc Nephrol 23:1631–1634

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Ito T, Tanaka I, Kadoya T, Kimura M, Ooshiro T, Ooishi K, Tanaka J, Yorioka N (1999) Screening for gastroenterological malignancies in new and maintenance dialysis patients. J Gastroenterol 34:35–40

    Article  CAS  PubMed  Google Scholar 

  21. Maisonneuve P, Agodoa L, Gellert R, Stewart JH, Buccianti G, Lowenfels AB, Wolfe RA, Jones E, Disney AP, Briqqs D, McCredie M, Boyle P (1999) Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet 354:93–99

    Article  CAS  PubMed  Google Scholar 

  22. Fedirko V, Bostick RM, Goodman M, Flanders WD, Gross MD (2010) Blood 25-hydroxyvitamin D3 concentrations and incident sporadic colorectal adenoma risk: a pooled case-control study. Am J Epidemiol 172:489–500

    Article  PubMed Central  PubMed  Google Scholar 

  23. Bilinski C, Burleson J, Forouhar F (2012) Inflammation associated with neoplastic colonic polyps. Ann Clin Lab Sci 42:266–270

    PubMed  Google Scholar 

  24. Winawer SJ, Fletcher RH, Miller L, Godlee F, Stolar MH, Mulrow CD, Woolf SH, Glick SN, Ganiats TG, Bond JH, Rosen L, Zapka JG, Olsen SJ, Giardiello FM, Sisk JE, Van Antwerp R, Brown-Davis C, Marciniak DA, Mayer RJ (1997) Colorectal cancer screening: clinical guidelines and rationale. Gastroenterology 112:594–642

    Article  CAS  PubMed  Google Scholar 

  25. Escolar G, Díaz-Ricart M, Cases A (2005) Uremic platelet dysfunction: past and present. Curr Hematol Rep 4:359–367

    CAS  PubMed  Google Scholar 

  26. Boccardo P, Remuzzi G, Galbusera M (2004) Platelet dysfunction in renal failure. Semin Thromb Hemost 30:579–589

    Article  CAS  PubMed  Google Scholar 

  27. Brenner H, Tao S, Haug U (2010) Low-dose aspirin use and performance of immunochemical fecal occult blood tests. JAMA 304:2513–2520

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A1A1009690).

Conflict of interest

The authors declare that they have no conflicting interests and no financial disclosures.

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Author notes

    Authors and Affiliations

    1. Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

      Yoo A Choi, Sang Hoon Yoo, Se Young Kim, Yunju Nam, Sooa Choi, Hye Eun Yoon, Yu Ah Hong, Yoon Kyung Chang, Chul Woo Yang, Suk Young Kim & Hyeon Seok Hwang

    2. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

      Youn Mi Song & Bong Han Kong

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    1. Yoo A Choi
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    Correspondence to Hyeon Seok Hwang.

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    Choi, Y.A., Yoo, S.H., Song, Y.M. et al. Diagnostic utility of immunochemical fecal occult blood tests to detect lower gastrointestinal lesions in patients with chronic kidney disease. Int J Colorectal Dis 30, 919–925 (2015). https://doi.org/10.1007/s00384-015-2200-3

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    • DOI: https://doi.org/10.1007/s00384-015-2200-3

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