Prevalence and Pattern of Upper Gastrointestinal Lesions in Prospective Kidney Transplant Patients in Bangladesh.

Abstract

Background: Upper gastrointestinal (GI) lesions are common in patients with chronic kidney disease and may contribute to anemia and increased morbidity, especially in patients on hemodialysis (HD). They become even more significant in patients undergoing kidney transplantation about to be subjected to lifelong immunosuppressive drugs.

Materials and methods: This cross-sectional study conducted at Bangabandhu Sheikh Mujib Medical University's Departments of Gastroenterology and Nephrology analyzed 128 prospective kidney transplant patients following upper GI endoscopy. Lesions were histopathologically examined and factors contributing to and consequences of the lesions were investigated.

Results: A total of 52.3% patients had at least one upper GI lesion. Gastritis was the most prevalent one, comprising 55.7% of the lesions, followed by duodenitis (21.6%), ulcer (12.5%), esophagitis (2.3%), and others (8%). Lesions did not vary significantly between symptomatic and asymptomatic patients (p = 0.9). Those on HD had 3.6-fold higher odds of having a lesion (p = 0.005). Patients with lesions had significantly longer CKD duration (p = 0.0002). Mean hemoglobin level was 8.8 g/dl in those with lesions, which was significantly lower compared to those without lesion, who had a mean of 10.3 g/dl (p < 0.0001). Iron deficiency was more common in patients with lesions (p = 0.0004). The mean serum calcium level was significantly higher in patients with lesions (p = 0.0002).

Conclusion: Upper GI lesions are fairly common in Bangladeshi CKD population. Routine endoscopic screening and treatment of asymptomatic lesions are recommended for advanced CKD patients in Bangladesh, given their frequency and potential impact.