title: Symptomatic Diverticular Disease in Patients With Severely Reduced Kidney Function: Higher Rates of Complications and Transfusion Requirement.
abstract: BACKGROUND
  The prevalence of diverticulosis is increasing with 5-10% of patients developing diverticulitis and 5-15% developing symptomatic bleeding. Diverticulitis can result in abscess, perforation, fistula, or obstruction. Bleeding has combined morbidity and mortality rates of 10-20%. The purpose of this study was to compare diverticulitis-related complications and transfusion requirements for diverticular bleeding in patients with normal to moderately reduced kidney function (glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m2) and patients with severe renal impairment (GFR < 30 mL/min/1.73 m2), and identify factors associated with these outcomes.
  
  
  METHODS
  We retrospectively reviewed records of all patients with diverticulitis and diverticular bleeding treated at our hospital from January 1, 2011 to July 31, 2016. Patients were evaluated for baseline characteristics, GFR, baseline hemoglobin, medications, comorbidities, length of stay (LOS), presence of perforations or abscesses and the need for transfusion.
  
  
  RESULTS
  Of the 291 patients included, males were 167 (58%). Perforations and abscesses complicating diverticulitis developed in 31/136 (23%) of patients with GFR ≥ 30 mL/min/1.73 m2, and in 13/26 (50%) of patients with GFR < 30 mL/min/1.73 m2(odds ratio (OR): 3.4; 95% confidence interval (CI): 1.423 - 8.06; P = 0.0073). Mean LOS (days) was 6.3 ± 4 in the GFR ≥ 30 mL/min/1.73 m2group and 8.5 ± 4.4 in GFR < 30 mL/min/1.73 m2group (P = 0.0001). Blood transfusion for diverticular bleeding occurred in 11/78 (14%) of patients with GFR ≥ 30 mL/min/1.73 m2and in 22/51 (43%) of patients with GFR < 30 mL/min/1.73 m2(OR: 4.6; 95% CI: 1.99 - 10.76; P = 0.0004). Among patients who needed transfusion, mean LOS was 8.5 ± 2.5 in GFR ≥ 30 mL/min/1.73 m2group and 9 ± 5 in those with GFR < 30 mL/min/1.73 m2(P = 0.04). There were no differences in age, gender or race between the study groups.
  
  
  CONCLUSIONS
  There was a significant increase in complicated diverticulitis cases, transfusion requirements for diverticular bleeding and LOS in patients with severely reduced kidney function compared to patients with normal-moderately reduced renal function.
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Dirweesh
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Afolarin
authors.initials: A
authors.lastname: Amodu
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Ritika
authors.initials: R
authors.lastname: Zijoo
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Bushra
authors.initials: B
authors.lastname: Ambreen
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ibrahim
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ijaz
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Abdelhameed
authors.initials: A
authors.lastname: Nawwar
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Kareem
authors.initials: K
authors.lastname: Genena
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Tahir
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Internal Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Debari
authors.affiliation: Department of Internal Medicine, Seton Hall University, Saint Francis Medical Center, Trenton, NJ, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Wallach
keywords: Bleeding; Diverticulitis; GFR; Renal failure