Insuficiência renal crónica em hemodiálise: um fator de risco independente para angiodisplasias na enteroscopia por videocápsula na hemorragia digestiva obscura

Abstract

Introduction

The spectrum of small bowel pathology in terminal renal failure (TRF) - dialysis patients is not well characterized in the literature. The aim of this study was to evaluate the role of the wireless capsule enteroscopy (WCE) in the management of obscure digestive bleeding (ODB) in patients with chronic renal failure (CRF) undergoing haemodialysis, in comparison to a group of patients with creatinine clearance (CrCl) >60 mL/min.

Material and methods

This prospective cohort study included 90 patients with ODB: 12 patients with CrCl <30mL/min undergoing haemodialysis and 78 patients with CrCl >60 mL/min, all referred for WCE in a single institution in a 12 month-period. Estimated CrCL using Cockcroft-Gault formula was determined in the day of WCE for all patients. Patient's demographic data and clinical characteristics, WCE findings and outcome (including specific therapy, transfusion requirements and hospital admissions due to recurrent bleeding or severe anemia) were assessed.

Results

Patients’ age and the clinical presentation of ODB (occult/overt) were similar in the 2 groups. There were no significant differences in gastric emptying and small bowel transit times, or in the ratio of incomplete/inconclusive exams. In patients undergoing haemodialysis, there were fewer normal WCE procedures (17% versus 46%, respectively, p=0,031) and a higher prevalence of small bowel angiodysplasias (58% versus 23%, respectively, p=0,011). By logistic regression analysis, CRF in haemodyalisis was found to be the only predictive factor for angiodysplasias in WCE (p=0,017, 95% CI 0,061-0,758). The group of patients undergoing haemodyalisis also had greater transfusion requirements and hospital admissions due to bleeding recurrence/severe anaemia during the follow-up period (average time, 7,5 months).

Conclusions

This prospective study demonstrated that haemodyalisis is an independent predictive factor for angiodysplasias in WCE for ODB.