Gastrointestinal system endoscopy and pathological findings in non-dialysis chronic kidney disease: A single-center study

Abstract

Background: Different gastrointestinal complications can occur due to moderate and severe kidney function loss in chronic kidney disease (CKD). This study examined the endoscopic and pathological findings in CKD patients with renal failure who were not receiving dialysis treatment and renal transplantation. Material/Methods: A total of 60 pre-dialysis CKD patients who underwent upper-gastrointestinal endoscopy due to dyspeptic concerns were included. Endoscopic and pathological findings were compared with those of 68 non-uremic patients with similar concerns. Dyspeptic symptoms included upper-abdominal discomfort, nausea, vomiting, anorexia, indigestion, and regurgitation. Serum creatinine levels >= 1.5 mg/dL and eGFR stages 3a-4 (KDIGO guidelines) were used to define CKD. Results: This study found no significant difference in gastroesophageal reflux frequency between the groups. However, antral gastritis, erythematous gastritis, active chronic gastritis, and non-ulcerative lesions were significantly more frequent in CKD patients (P<0.001). Conversely, erosive pangastritis was more prevalent in the nonCKD group. Helicobacter pylori (HP) frequency was significantly lower in CKD patients (23.5%) compared to the non-CKD group (59.1%, P<0.001). Intestinal metaplasia, atrophy, and metaplastic gastritis rates were similar in both groups. Multivariate analysis identified gastritis and serum calcium as independent factors affecting HP positivity. Conclusions: In CKD patients, uremic toxins, impaired circulation, and hypergastrinemia likely contribute to mucosal damage and increased the risk of gastrointestinal complications. Early detection and management of these lesions in pre-dialysis CKD patients are crucial, especially for kidney transplant candidates. Endoscopic evaluation and appropriate treatment can help reduce potential complications associated with immunosuppressive therapy and can improve patient outcomes.