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Int J Med Sci 2012; 9(8):634-641. doi:10.7150/ijms.4969

Research Paper

Decisive Indicator for Gastrointestinal Workup in Anemic Patients with Nondialysis Chronic Kidney Disease

Hyeon Seok Hwang1, Youn Mi Song2, Eun Oh Kim1, Eun Sil Koh1, Hye Eun Yoon1, Sung Jin Chung1, Sang Ju Lee1, Yoon Kyung Chang1, Chul Woo Yang1, Yoon Sik Chang1, Suk Young Kim1✉

1. Division of Nephrology, Departments of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
2. Division of Gastroenterology, Departments of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background: Anemia and iron deficiency are universal problems in patients with chronic kidney disease (CKD). However, decisive indicator to guide the further gastrointestinal (GI) workup has not been determined.

Methods: We included 104 anemic patients with nondialysis-dependent CKD stages 3-5 (38 patients at stage 3, 26 patients at stage 4, and 40 patients at stage 5). Hemoglobin, serum ferritin, transferrin saturation (TSAT), mean corpuscular volume (MCV), and corrected reticulocyte count data were assessed to evaluate diagnostic utility for bleeding-related GI lesions, which were identified by esophagogastroduodenoscopy and colonoscopy.

Results: Bleeding-related GI lesions were found in 55 (52.9%) patients, and patients with stage 5 CKD had a higher prevalence of gastric lesions than patients with CKD stage 3 or 4 (all p < 0.05). The areas under the receiver operating characteristic curves used to predict bleeding-related lesions were 0.69 for TSAT (p = 0.002) and 0.61 for serum ferritin (p = 0.085). The sensitivity and specificity of a cutoff value for TSAT < 20% were 0.59 and 0.74, respectively. Hemoglobin, MCV, and corrected reticulocyte levels had no significant diagnostic utility. On multivariable logistic regression, the chance of GI lesions increased by 6% for each 1% reduction in TSAT and increased 4.1-fold for patients with CKD stage 5 (all p < 0.05).

Conclusions: TSAT is a useful indicator for determining the GI workup in anemic patients with nondialysis-dependent CKD stages 3-5. Stage 5 CKD is independently associated with bleeding-related lesions and TSAT should be used cautiously in these patients.

Keywords: Chronic kidney disease, anemia, endoscopy

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How to cite this article:
Hwang HS, Song YM, Kim EO, Koh ES, Yoon HE, Chung SJ, Lee SJ, Chang YK, Yang CW, Chang YS, Kim SY. Decisive Indicator for Gastrointestinal Workup in Anemic Patients with Nondialysis Chronic Kidney Disease. Int J Med Sci 2012; 9(8):634-641. doi:10.7150/ijms.4969. Available from http://www.medsci.org/v09p0634.htm