Diagnostic utility of immunochemical fecal occult blood tests to detect lower gastrointestinal lesions in patients with chronic kidney disease

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• 作者：Yoo A Choi ; Sang Hoon Yoo ; Youn Mi Song…
• 关键词：Chronic kidney disease ; Fecal occult blood ; Lower gastrointestinal tract
• 刊名：International Journal of Colorectal Disease
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：30
• 期：7
• 页码：919-925
• 全文大小：216 KB
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• 作者单位：Yoo A Choi (1)
  Sang Hoon Yoo (1)
  Youn Mi Song (2)
  Se Young Kim (1)
  Yunju Nam (1)
  Sooa Choi (1)
  Bong Han Kong (2)
  Hye Eun Yoon (1)
  Yu Ah Hong (1)
  Yoon Kyung Chang (1)
  Chul Woo Yang (1)
  Suk Young Kim (1)
  Hyeon Seok Hwang (1)
  
  1. Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  2. Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Internal Medicine
  Gastroenterology
  Hepatology
  Proctology
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1262

文摘

Purpose The immunochemical fecal occult blood test (iFOBT) is a useful method to screen for lower gastrointestinal (GI) bleeding-related lesions. However, few studies have investigated the diagnostic utility of iFOBT in chronic kidney disease (CKD). Methods We included 691 patients with nondialysis-dependent CKD stages 2- or those receiving dialysis. Bleeding-related lower GI lesions were identified by colonoscopy, and the diagnostic utility of iFOBT was evaluated. Results Bleeding-related lower GI lesions were found in 9.2?% of 491 patients with CKD stage 2, 17.8?% of 107 patients with CKD stage 3/4, and 25.8?% of 93 patients with CKD stage 5/dialysis (p-lt;-.001). Compared with CKD stage 2, CKD stage 5/dialysis was independently associated with a 2.80-fold risk for bleeding-related lesions (p--.019). The iFOBT was positive in 92 (13.3?%) patients and the area under the receiver operating curve (AUC) for a bleeding-related lesion was 0.64 (p-lt;-.001). The sensitivity of iFOBT increased as the CKD stage worsened (20.0 vs 52.6 vs 58.3?%; p--.002). However, the specificity to detect bleeding-related lesions decreased with the severity of CKD stage (94.6 vs. 78.4 vs. 76.8?%; p-lt;-.001). The AUC of iFOBT to detect adenoma or carcinoma was 0.54 (p--.046), and a similar pattern of sensitivity and specificity was observed between different CKD stages. Conclusions The prevalence of bleeding-related lower GI lesions and the sensitivity of iFOBT to detect these GI lesions increased in advanced CKD. However, iFOBT should be used cautiously in these patients because its specificity decreased.