Prevalence and risk factors for colonic perforation during colonoscopy in hospitalized end-stage renal disease patients on hemodialysis.
OBJECTIVE
Colonic perforation is a rare complication during colonoscopy. A recent single center study reported a high incidence of colonic perforation in end-stage renal disease (ESRD) patients on hemodialysis (HD) who underwent colonoscopy. We sought to determine nationwide, population-based prevalence in rates of colonic perforation during colonoscopy among ESRD inpatients on HD in the US, and to assess risk factors for colonic perforation in this patient population.


METHODS
We obtained patient data from the Nationwide Inpatient Sample and used the International Classification of Diseases, the 9th revision, clinical modification codes, to identify ESRD patients on HD who had undergone colonoscopy in 2006. The control group consisted of inpatients who had colonoscopy without ESRD.


RESULTS
Colonic perforations occurred in 51/17,000 ESRD hospitalizations on HD (0.3%) and 3,951/564,428 controls without ESRD (0.7%). The risk of colonic perforation among the study group was not significantly higher than the control group even after adjusting for patient demographics like age, gender and comorbid conditions (adjusted odds ratio [aOR] -0.55; 95% confidence interval [CI], 0.30-0.97). Older age (OR -1.007; 95% CI, 1.002-1.011) and female gender (OR -1.18; 95% CI, 1.03-1.36) were identified as independent risk factors for the risk of perforation in this population group.


CONCLUSIONS
There appeared no increased risk of colonic perforation during colonoscopy among inpatients who received HD in our study. Increasing age and female patients appeared to be associated with procedure-related colonic perforation.
Digestive disease Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. udhaykumar81@gmail.com
Udayakumar
U
Navaneethan
Sravanthi
S
Parasa
Preethi G K
PG
Venkatesh
Bo
B
Shen
D000293:Adolescent; D000328:Adult; D000368:Aged; D003113:Colonoscopy / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult