Saumoy Monica, Jesudian Arun B, Aden Brandon, Serur David, Sundararajan Subha, Sivananthan Geethan, Gambarin-Gelwan Maya
Department of Gastroenterology, Weill Cornell Medical College, New York, NY, USA.
Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
Clin Transplant. 2016 Mar;30(3):256-62. doi: 10.1111/ctr.12684. Epub 2016 Jan 30.
The aim of this study was to determine whether patients with end-stage kidney disease (ESKD) on hemodialysis (HD) undergoing kidney transplant evaluation are at higher risk for colonic neoplasia than the general population. This is a retrospective cohort study of patients with ESKD who underwent a first screening colonoscopy while undergoing kidney transplant evaluation. Data were collected on the prevalence of adenomatous polyps and advanced adenomas in 70 patients with ESKD and 70 controls, undergoing their first screening colonoscopy, matched for age, gender, and endoscopist. At the time of the colonoscopy, an average time on HD was 3.2 ± 2.9 yr. The prevalence of adenomatous polyps was significantly higher in ESKD on HD (54.3% vs. 32.9%, p = 0.008) than in controls. In a multivariate analysis controlling for other factors, ESKD on HD remained a risk factor for the presence of adenomas (OR 3.06, 95% CI 1.21, 7.73). No colonoscopy-related complications were reported in the patients with ESKD on HD. We demonstrate a significantly higher prevalence of adenomatous polyps in patients with ESKD undergoing a first screening colonoscopy as part of kidney transplant evaluation. In addition, colonoscopy can be safely performed in this population.
本研究的目的是确定接受肾移植评估的终末期肾病（ESKD）血液透析（HD）患者患结肠肿瘤的风险是否高于普通人群。这是一项对接受首次筛查结肠镜检查的ESKD患者进行的回顾性队列研究，这些患者同时正在接受肾移植评估。收集了70例ESKD患者和70例对照者首次筛查结肠镜检查时腺瘤性息肉和高级别腺瘤的患病率数据，对照者在年龄、性别和内镜医师方面进行了匹配。结肠镜检查时，HD的平均时间为3.2±2.9年。HD的ESKD患者腺瘤性息肉的患病率（54.3%对32.9%，p = 0.008）显著高于对照组。在控制其他因素的多变量分析中，HD的ESKD仍然是腺瘤存在的危险因素（OR 3.06，95%CI 1.21，7.73）。HD的ESKD患者未报告与结肠镜检查相关的并发症。我们证明，作为肾移植评估一部分接受首次筛查结肠镜检查的ESKD患者腺瘤性息肉的患病率显著更高。此外，该人群可以安全地进行结肠镜检查。
