Decisive indicator for gastrointestinal workup in anemic patients with nondialysis chronic kidney disease.
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.
Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Hyeon Seok
HS
Hwang
Youn Mi
YM
Song
Eun Oh
EO
Kim
Eun Sil
ES
Koh
Hye Eun
HE
Yoon
Sung Jin
SJ
Chung
Sang Ju
SJ
Lee
Yoon Kyung
YK
Chang
Chul Woo
CW
Yang
Yoon Sik
YS
Chang
Suk Young
SY
Kim
D000368:Aged; D000740:Anemia / Q000150:complications / Q000503:physiopathology*; D003113:Colonoscopy; D016145:Endoscopy, Digestive System; D005260:Female; D006471:Gastrointestinal Hemorrhage; D041981:Gastrointestinal Tract / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged