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Karahan D, Şahin İ. Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease. Hemodial Int 2024. [PMID: 38558287 DOI: 10.1111/hdi.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION The prevalence rates of hepatosteatosis and gallstones are increasing owing to the multifactorial causes of chronic kidney disease, and the prevalence may change with the availability of different forms of renal replacement therapy. We aimed to determine the incidence or prevalence rates of hepatosteatosis, cholelithiasis, and acute cholecystitis in patients with chronic kidney disease and compare them between renal replacement therapy modalities. METHODS A total of 270 patients (90 with chronic kidney disease stages III-V, 90 undergoing peritoneal dialysis, and 90 undergoing hemodialysis) were included and categorized into the pre-dialysis, hemodialysis, and peritoneal dialysis groups. The patients were questioned about previous gallbladder surgeries and chronic diseases. The results of abdominal ultrasonography, tomography, and magnetic resonance imaging were retrospectively evaluated with respect to the findings on the hepatobiliary system. Hepatosteatosis and cholelithiasis were diagnosed by expert radiologists on the basis of abdominal ultrasonography, tomography, and magnetic resonance imaging findings. The prevalence rates of hepatosteatosis, cholelithiasis, and other liver findings were compared between the groups. FINDINGS Hepatosteatosis and cholelithiasis were detected in 16.7% and 21.5% of the 270 cases, respectively. Hepatosteatosis was present in 17.8%, 25.6%, and 6.7% of patients in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively. The prevalence of hepatosteatosis was significantly higher in patients undergoing hemodialysis than in patients undergoing peritoneal dialysis (p = 0.002). However, no statistically significant difference was found between the peritoneal dialysis and pre-dialysis groups or between the hemodialysis and pre-dialysis groups (p >0.05). The prevalence rates of cholelithiasis were 15.6%, 28.9%, and 20.0%, in the pre-dialysis, hemodialysis, and peritoneal dialysis groups, respectively, and there were no statistically significant differences among the groups. The incidence of acute cholecystitis was significantly higher in the hemodialysis group than in the pre-dialysis group (p = 0.006). DISCUSSION Our study showed that the hepatobiliary system is frequently affected in chronic kidney disease and that the findings may differ depending on the renal replacement therapy modality.
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Affiliation(s)
- Doğu Karahan
- Department of Internal Medicine, Malatya Turgut Özal University School of Medicine, Malatya, Turkey
| | - İdris Şahin
- Department of Nephrology, İnonu University School of Medicine, Malatya, Turkey
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Choi H, Kwon SK, Han JH, Lee JS, Kang G, Kang M. Incidence of acute cholecystitis underwent cholecystectomy in incident dialysis patients: a nationwide population-based cohort study in Korea. Kidney Res Clin Pract 2021; 41:253-262. [PMID: 34974655 PMCID: PMC8995489 DOI: 10.23876/j.krcp.20.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 06/28/2021] [Indexed: 12/07/2022] Open
Abstract
Background Patients on dialysis have numerous gastrointestinal problems related to uremia, which may represent concealed cholecystitis. We investigated the incidence and risk of acute cholecystitis in dialysis patients and used national health insurance data to identify acute cholecystitis in Korea. Methods The Korean National Health Insurance Database was used, with excerpted data from the insurance claim of the International Classification of Diseases code of dialysis and acute cholecystitis treated with cholecystectomy. We included all patients who commenced dialysis between 2004 and 2013 and selected the same number of controls via propensity score matching. Results A total of 59,999 dialysis and control patients were analyzed; of these, 3,940 dialysis patients (6.6%) and 647 controls (1.1%) developed acute cholecystitis. The overall incidence of acute cholecystitis was 8.04-fold higher in dialysis patients than in controls (95% confidence interval, 7.40–8.76). The acute cholecystitis incidence rate (incidence rate ratio, 23.13) was especially high in the oldest group of dialysis patients (aged ≥80 years) compared with that of controls. Dialysis was a significant risk factor for acute cholecystitis (adjusted hazard ratio, 8.94; 95% confidence interval, 8.19–9.76). Acute cholecystitis developed in 3,558 of 54,103 hemodialysis patients (6.6%) and in 382 of 5,896 patients (6.5%) undergoing peritoneal dialysis. Conclusions Patients undergoing dialysis had a higher incidence and risk of acute cholecystitis than the general population. The possibility of a gallbladder disorder developing in patients with gastrointestinal problems should be considered in the dialysis clinic.
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Affiliation(s)
- Hanlim Choi
- Department of Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Soon Kil Kwon
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jun Su Lee
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Gilwon Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Minseok Kang
- Department of Health Information and Management, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
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Complications of cholecystitis: a comprehensive contemporary imaging review. Emerg Radiol 2021; 28:1011-1027. [PMID: 34110530 DOI: 10.1007/s10140-021-01944-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
Acute cholecystitis is a common cause of right upper quadrant pain in patients presenting to the emergency department. Ultrasound, computed tomography, HIDA scans, and magnetic resonance imaging are increasingly utilized to evaluate suspected cases. The prognosis of acute cholecystitis is usually excellent with timely diagnosis and management. However, complications associated with cholecystitis pose a considerable challenge to the clinician and radiologist. Complications of acute cholecystitis may result from secondary bacterial infection or mural ischemia secondary to increased intramural pressure. The recognized subtypes of complicated cholecystitis are hemorrhagic, gangrenous, and emphysematous cholecystitis, as well as gallbladder perforation. Acute acalculous cholecystitis is a form of cholecystitis that occurs as a complication of severe illness in the absence of gallstones or without gallstone-related inflammation. Complicated cholecystitis may cause significant morbidity and mortality, and early diagnosis and recognition play a pivotal role in the management and early surgical planning. As appropriate utilization of imaging resources plays an essential role in diagnosis and management, the emergency radiologist should be aware of the spectrum of complications related to cholecystitis and the characteristic imaging features. This article aims to offer a comprehensive contemporary review of clinical and cross-sectional imaging findings of complications associated with cholecystitis. In conclusion, cross-sectional imaging is pivotal in identifying the complications related to cholecystitis. Preoperative detection of this complicated cholecystitis can help the care providers and operating surgeon to be prepared for a potentially more complicated procedure and course of recovery.
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Fujioka H, Imamura T, Kinugawa K. Acute acalculous cholecystitis in a very elderly peritoneal dialysis patient. Ther Apher Dial 2020; 25:535-536. [PMID: 32870606 DOI: 10.1111/1744-9987.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Hayato Fujioka
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
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Lo CH, Hsu YJ, Hsu SN, Lin C, Su SL. Factors associated with length of hospital stay among dialysis patients with nontraumatic acute abdomen: a retrospective observational study. Singapore Med J 2019; 61:605-612. [PMID: 31489428 DOI: 10.11622/smedj.2019106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Nontraumatic acute abdomen (NTAA) in dialysis patients is a challenging issue. The aetiologies of NTAA vary considerably depending on the renal replacement therapy (RRT) modality. Although haematological parameters and contributing factors have been reported to be associated with outcomes for dialysis patients, their clinical effect on the length of hospital stay (LOS) remains unknown. METHODS We retrospectively analysed 52 dialysis patients (peritoneal dialysis [PD], n = 33; haemodialysis [HD], n = 19) and 30 non-dialysis patients (as controls) between January 2011 and December 2014. To attenuate the selection bias, non-dialysis patients with NTAA were matched to cases at a ratio of 1:1 by age, gender and comorbidities (diabetes mellitus and hypertension). Their demographic characteristics, laboratory data, clinical assessment scores and LOS were analysed. RESULTS The PD group exhibited a significantly higher neutrophil percentage, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR); longer LOS; and lower lymphocyte percentage and absolute lymphocyte count than the control group. After multivariate analysis adjustment, female gender, longer RRT duration and higher intact parathyroid hormone (iPTH) levels were associated with a lower probability of being discharged home. In the dialysis group, a higher iPTH level (> 313 μg/mL) was positively correlated with longer LOS. iPTH level combined with NLR can be used as a surrogate marker for predicting longer LOS (p < 0.001). CONCLUSION NTAA dialysis patients with female gender, longer RRT duration and higher iPTH levels are prone to experiencing longer LOS. In addition, the combination of iPTH and NLR is a significant determinant for LOS in NTAA dialysis patients.
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Affiliation(s)
- Chang-Han Lo
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Science, National Defense Medical Center, Taipei, Taiwan
| | - Shun-Neng Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Sui-Lung Su
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
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Wu YL, Lin YS, Hsueh TYR, Lo WC, Peng KC, Kao MJ. Green dialysate and gallbladder perforation in a peritoneal dialysis patients: a case report and literature review. BMC Nephrol 2018; 19:165. [PMID: 29973169 PMCID: PMC6033235 DOI: 10.1186/s12882-018-0974-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gallbladder perforation is a rare but lethal condition and its diagnosis is usually difficult and delayed. Frequently, gallbladder rupture is associated with cholecystitis, but spontaneous perforation was ever described. However, spontaneous rupture of gallbladder has never been reported in patients underwent peritoneal dialysis. CASE PRESENTATION We report a 62-year-old man who presented with abdominal pain for 2 days to clinic. Peritoneal dialysis-related peritonitis was diagnosed initially. It was followed by spontaneous gallbladder perforation with greenish dialysate. The patient was managed successfully by antibiotic treatment and primary closure of gallbladder perforation with external drainage. He recovered from this critical condition and stayed on dialysis. CONCLUSIONS Early diagnosis and timely surgical intervention yields a good prognosis in PD patients with gallbladder perforation. Surgical intervention and antibiotic treatment are the mainstay of treatment. Both of them should take place promptly.
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Affiliation(s)
- Yueh-Lin Wu
- Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei, 115 Taiwan
| | - Yi-Sheng Lin
- Department of Nephrology, Taipei City Hospital, Zhongxiao Branch, No. 87, Tongde Road, Nangang District, Taipei, 115 Taiwan
| | | | - Wen-Ching Lo
- Division of Gastroenterology, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Kuo-Chou Peng
- Division of Medical Imaging, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
| | - Mu-Jung Kao
- Division of Rehabilitation, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan
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Chung PJ, Smith MC, Roudnitsky V, Lee JS, Alfonso AE, Sugiyama G. A Calculated Risk: Performing Laparoscopic Cholecystectomy for Acute Cholecystitis on Patients with End Stage Renal Disease. Am Surg 2018. [DOI: 10.1177/000313481808400649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
End-stage renal disease (ESRD) is a multifactorial disease linked to socioeconomic status and associated with worse surgical outcomes. We explore intraoperative and postoperative outcomes in patients with cholecystitis undergoing laparoscopic cholecystectomy (LC). The Nationwide Inpatient Sample from 2005 to 2012 was used to identify patients undergoing LC for cholecystitis using ICD-9 codes. Outcomes of interest were mortality, common bile duct injury, conversion to open, intraoperative complications, postoperative complications, length of stay (LOS), and total charge. Univariate analysis was performed using t test for continuous variables and chi-squared test for categorical variables. Multivariable models were created that adjusted for age, demographics, year of admission, comorbidities, and presence of ESRD. Of 225,058 patients that underwent LC, 2,115 had ESRD. On univariate analysis, the ESRD cohort had a higher incidence of mortality and complications: intraoperative, mechanical wound, respiratory, cardiovascular, and postoperative infections. ESRD patients had higher median LOS and total charge. Multi-variate analysis showed ESRD as an independent risk factor for mortality, mechanical wound complications, and intraoperative complications. Negative binomial regression analysis showed that ESRD patients had LOS 50.4 per cent longer than non-ESRD patients. Linear regression analysis showed that, after adjustment, ESRD patients had total charge 6.82 per cent higher than non-ESRD patients. In this large retrospective analysis, we find that after adjusting for clinical, socioeconomic, and demographic variables, ESRD is an independent risk factor for increased mortality, intraoperative complications, mechanical wound complications, increased LOS, and cost for patients undergoing LC. Prospective studies exploring risk optimization strategies for patients with ESRD are warranted.
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Affiliation(s)
- Paul J. Chung
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Michael C. Smith
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Valery Roudnitsky
- Department of Surgery, Kings County Hospital Center, Brooklyn, New York
| | - Jun Seon Lee
- State University of New York Downstate College of Medicine, Brooklyn, New York
| | - Antonio E. Alfonso
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Gainosuke Sugiyama
- Department of Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
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Liao CY, Tsai CC, Kuo WH, Ben RJ, Lin HC, Lee CC, Su KJ, Wang HE, Wang CC, Chen IH, Chien ST, Tsai MK. Emphysematous cholecystitis presenting as gas-forming liver abscess and pneumoperitoneum in a dialysis patient: a case report and review of the literature. BMC Nephrol 2016; 17:23. [PMID: 26932814 PMCID: PMC4774179 DOI: 10.1186/s12882-016-0237-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/19/2016] [Indexed: 12/19/2022] Open
Abstract
Background Emphysematous cholecystitis is a rare variant of acute cholecystitis with a high mortality rate. The combination of emphysematous cholecystitis, liver abscess and pneumoperitoneum are even rarer. Herein we present a case of emphysematous cholecystitis in a senile diabetic lady who had worsening hemodynamics while undergoing hemodialysis. Case presentation A 64-year-old woman with history of type 2 diabetes mellitus and end stage renal disease with regular hemodialysis presented to the emergency department with a 1-day history of sudden onset of lassitude and hypotension during hemodialysis. The result of a computed tomography (CT)-scan revealed air encircling the gallbladder, liver parenchymal and minimal pneumoperitoneal and liver abscess with no cholelithiasis. The patient had received empirical antibiotics with piperacillin-tazobactam 2.25 g intravenous route every 6 h for 14 days and cholecystectomy with surgical debridement and lead an uneventful postoperative hospital course. Escherichia coli was demonstrated as well as blood culture and peritoneal fluid culture. Conclusion In a senile diabetic and dialysis patient, we should take emphysematous cholecystitis into consideration once vague abdominal pain occurrs. Empirical antibiotic therapy and adequate surgical intervention should take place as soon as possible.
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Affiliation(s)
- Chen-Yi Liao
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C. .,Department of Internal medicine, Division of Nephrology, Tri-service general hospital, National defense Medical center, No.325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan R.O.C.
| | - Chi-Chang Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Wu-Hsien Kuo
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ren-Jy Ben
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ho-Cheng Lin
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Ching-Chang Lee
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Kuan-Jen Su
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Han-En Wang
- Department of Internal medicine, Division of Nephrology, Tri-service general hospital, National defense Medical center, No.325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan R.O.C.
| | - Chih-Chiang Wang
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - I-Hung Chen
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
| | - Shang-Tao Chien
- Department of Pathology, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan R.O.C.
| | - Ming-Kai Tsai
- Department of Medicine, Kaohsiung Armed Forces General Hospital, No.2, Zhongzheng 1st Rd, Lingya Dist, Kaohsiung City, 802, Taiwan R.O.C.
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