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Karahan D, Şahin İ. Evaluation of hepatosteatosis and gallstone disease in patients with chronic kidney disease. Hemodial Int 2024; 28:343-350. [PMID: 38558287 DOI: 10.1111/hdi.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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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Park SK, Jung JY, Oh CM, Kim MH, Ha E, Lee DY, Kim JW, Kang HY, Ryoo JH. The Level of Urine Dipstick Proteinuria and Its Relation to the Risk of Incident Cholelithiasis. J Epidemiol 2020; 31:59-64. [PMID: 31956168 PMCID: PMC7738639 DOI: 10.2188/jea.je20190223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Previous studies have suggested the potential association between renal diseases and gallstone. The extent of proteinuria is recognized as a marker for the severity of chronic kidney disease. However, little data is available to identify the risk of incident gallstone according to the level of proteinuria. Methods Using a data of 207,356 Koreans registered in National Health Insurance Database, we evaluated the risk of gallstone according to the levels of urine dipstick proteinuria through an average follow-up of 4.36 years. Study subjects were divided into 3 groups by urine dipstick proteinuria (negative: 0, mild: 1+ and heavy: 2+ or greater). Multivariate Cox-proportional hazard model was used to assess the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident cholelithiasis according to urine dipstick proteinuria. Results The group with higher urine dipstick proteinuria had worse metabolic, renal, and hepatic profiles than those without proteinuria, which were similarly observed in the group with incident cholelithiasis. The heavy proteinuria group had the greatest incidence of cholelithiasis (2.39%), followed by mild (1.54%) and negative proteinuria groups (1.39%). Analysis for multivariate Cox-proportional hazard model indicated that the heavy proteinuria group had higher risk of cholelithiasis than other groups (negative: reference, mild proteinuria: HR 0.97 [95% CI, 0.74–1.26], and heavy proteinuria: HR 1.46 [95% CI, 1.09–1.96]). Conclusion Urine dipstick proteinuria of 2+ or greater was significantly associated with increased risk for incident gallstone.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine
| | - Ju Young Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine
| | - Chang-Mo Oh
- Departments of Preventive Medicine, School of Medicine, Kyung Hee University
| | - Min-Ho Kim
- Ewha Institute of Convergence Medicine, Ewha Womans University Mokdong Hospital
| | - Eunhee Ha
- Department of Occupational and Environment Medicine, College of Medicine, Ewha Womans University
| | - Dong-Young Lee
- Department of Internal Medicine, Veterans Healthcare Service Medical Center
| | - Jung-Wook Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University School of Medicine
| | - Hee Yong Kang
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital
| | - Jae-Hong Ryoo
- Departments of Occupational and Environmental Medicine, School of Medicine, Kyung Hee University
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Cariati A. Blackberry pigment (whitlockite) gallstones in uremic patient. Clin Res Hepatol Gastroenterol 2013; 37:e69-72. [PMID: 22959097 DOI: 10.1016/j.clinre.2012.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 07/28/2012] [Accepted: 08/03/2012] [Indexed: 02/04/2023]
Abstract
Black pigment gallstones represent nearly the 15% of all gallstones and are usually related with the typical "hyperbilirubinbilia" factors as hemolysis, ineffective erythropoiesis, pathologic enterohepatic cycling of unconjugated bilirubin, cirrhosis and with gallbladder mucosa (parietal) factors as adenomyomatosis. During a prospective study on 179 patients who underwent cholecystectomy for gallstone disease a 69-year-old female with predialysis chronic kidney disease was operated for symptomatic gallstone. The removed gallstones were black pigment gallstones, with an irregular (as small blackberry) surface. Analysis of the stones revealed a great amount of whitlockite (Ca Mg)3 (PO4)2. Recent studies on chronic renal failure patients found that chronic uremia is associated with an increased risk of gallstones formation (22%) as it seems in women affected by primary hyperparathyroidism (30%). The presence of calcium phosphate gallstones in these patients have been never described. In conclusion, further studies could be necessary to establish the role of chronic renal failure and of primary and secondary hyperparathyroidism in gallstones formation and, in particular, if dialysis and predialysis patients have an higher risk to develop cholesterol and black pigment gallstones in particular of the "blackberry" (whitlockite) subtype.
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Affiliation(s)
- Andrea Cariati
- General Surgery, San Martino, IST, University Hospital, Via Fratelli Coda 67/a, 16166 Genoa, Italy.
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Chen YT, Ou SM, Chao PW, Li SY, Chen TJ, Tsai LW, Chen TW. Acute cholecystitis in end-stage renal disease patients: a nation-wide longitudinal study. Dig Liver Dis 2013; 45:142-6. [PMID: 23021493 DOI: 10.1016/j.dld.2012.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 08/18/2012] [Accepted: 08/23/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the risks of acute cholecystitis among end-stage renal disease patients and compare the incidence between two dialysis modality. STUDY DESIGN In this retrospective cohort study, records of fifty thousand end-stage renal disease patients older than 20 years of age from 1998 to 2007 and an age, gender, Charlson's score, diabetes, and dyslipidemia matched control cohort were retrieved from Taiwan National Health Insurance Research Database. Hospitalizations for acute cholecystitis were retrieved using ICD-9-CM diagnosis codes and ICD-9-CM operation codes from in-patient claims. RESULTS The incidence rates were 5.8 per 1000 patient-years in the end-stage renal disease patients and 0.92 per 1000 patient-years in the control group. End-stage renal disease was an independent risk factor for acute cholecystitis. In the end-stage renal disease patients, independent risk factors were old age, higher Charlson's score, diabetes, severe liver disease, atrial fibrillation, and haemodialysis (all p<0.05). However, the peritoneal dialysis patients had a higher mortality rate after developing acute cholecystitis. CONCLUSION Acute cholecystitis is not uncommon in end-stage renal disease patients. The independent risk factors were older age, higher Charlson's score, atrial fibrillation, severe liver disease, diabetes, and dialysis modality. Haemodialysis patients had a higher risk of acute cholecystitis than PD patients.
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Affiliation(s)
- Yung-Tai Chen
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
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Liang CC, Wang IK, Kuo HL, Yeh HC, Lin HH, Liu YL, Hsu WM, Huang CC, Chang CT. Long-term use of fenofibrate is associated with increased prevalence of gallstone disease among patients undergoing maintenance hemodialysis. Ren Fail 2011; 33:489-93. [PMID: 21574895 DOI: 10.3109/0886022x.2011.577545] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In spite of insufficient evidence to guide the use of lipid-lowering drugs (LLDs) among the dialysis population, these drugs are frequently used to treat dyslipidemia. Several studies have found that long-term use of LLDs is associated with an increased risk of gallstone disease (GSD) in the general population. However, the lithogenic risk of LLDs in patients undergoing hemodialysis (HD) has not been studied. AIM It is to assess the influence of long-term use of LLDs on the prevalence of GSD among patients undergoing HD. METHODS This cross-sectional study included 108 eligible patients receiving maintenance HD: 35 receiving lovastatin; 34 fenofibrate; and 39 no LLD. GSD was defined as the presence of gallstones or the performance of cholecystectomy while taking LLD. Abdominal ultrasonography, demographic parameters, and laboratory data were obtained for all enrolled subjects. ANOVA with Bonferroni's test and chi-square test were used to compare differences among the three groups. RESULTS The three groups had similar clinical characteristics with regard to age, gender, duration of HD, body mass index, and total cholesterol values. However, a significantly higher prevalence of GSD and higher triglyceride levels were found in patients receiving fenofibrate, compared with those in other groups (p < 0.05). Among dialysis patients on fenofibrate, increased age, female gender, larger daily dose, and longer duration of treatment were associated with increased risks for GSD. CONCLUSIONS Our study shows that long-term use of fenofibrate is related to increased risk of GSD among HD patients. Further large-scale studies are needed to confirm our findings.
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Affiliation(s)
- Chih-Chia Liang
- Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
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Choi JH, Kang NL, Choi SD. Recent trends in the distribution of common bile duct stones in urban South Koreans. J Int Med Res 2009; 37:1220-4. [PMID: 19761707 DOI: 10.1177/147323000903700429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This retrospective, observational study was designed to analyse recent trends in the age distribution of westernized persons in South Korea with common bile duct stones (cholesterol, brown and black stones). Data on 253 patients who had received endoscopic surgery at a tertiary referral hospital in Daegu, the third largest South Korean city, were used to investigate the relationship between the numbers of patients with different types of common bile duct stones and age. There were strong correlations between age and the frequency of the three different types of common bile duct stones. The frequency of cholesterol stones decreased exponentially with increasing patient age, whereas the frequency of brown stones increased exponentially. Patients with black stones showed a Gaussian-like age distribution. Thus, the age-dependency of the frequency of these three common types of bile duct stones differed from one another within this patient population.
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Affiliation(s)
- J H Choi
- Department of Internal Medicine, Hankuk Hospital, Osan, Republic of Korea
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Bektas A, Belet U, Kelkitli E, Bakir T, Acikgoz A, Akpolat T. Ultrasonic Gallbladder Function in Chronic Kidney Disease: Does Predialysis, Hemodialysis, or CAPD Affect it? Ren Fail 2009; 27:677-81. [PMID: 16350817 DOI: 10.1080/08860220500234949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are contradictory reports about the prevalence of cholelithiasis in chronic kidney disease (CKD). The pathogenesis of gallstones is associated with the lithogenic changes of bile composition, increased tendency to nucleation, and decreased gallbladder motility. The studies related to these factors can predict the development of cholelithiasis. The aim of this study was to evaluate the ultrasonic gallbladder function in CKD and to compare it in predialysis (PreD), hemodialysis (HD), and continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS Age, gender, and body mass index matched 49 CKD patients (14 PreD, 19 HD, 16 CAPD), and 17 control individuals were included in the study. Diabetic and cirrhotic patients were not included. Ultrasonic gallbladder volume was evaluated in pre- and postprandial period, and ejection fraction was calculated. We also measured several biochemical parameters (cholesterol, triglyceride, blood urea nitrogen (BUN), creatinine, calcium, Phosphorus, parathormone, albumin, total protein) in blood. RESULTS Preprandial gallbladder volume in PreD, HD, CAPD, and control groups were 26.7 +/-13.6, 20.8+/-10.4, 23.2+/-14.7, and 26.4+/-14.8 mL, respectively (p > 0.05). Ejection fractions were 54.1 +/- 22.9%, 54.9 +/- 23.9%, 48.6 +/- 15.9%, and 51.8 +/- 19.2% in PreD, HD, CAPD, and control groups, respectively (p > 0.05). Serum triglyceride was higher in PreD patients than control group (207 +/- 144 vs. 110 +/-48 mg/dL) (p<0.05). Serum BUN, Cre, P, and PTH levels were higher in CKD groups than the control group, whereas serum total protein and albumin levels were higher in the control group (p<0.05). Serum Ca was lower in PreD and HD patients than in the controls (p<0.05). CONCLUSIONS In conclusion, CKD and renal replacement therapy (HD and CAPD) do not affect gallbladder functions, but more studies are needed to evaluate prevalence of gallstones, gallbladder motility, and the composition of bile in CKD.
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Affiliation(s)
- Ahmet Bektas
- Department of Gastroenterology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
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Laparoscopic Cholecystectomy in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis. Surg Laparosc Endosc Percutan Tech 2009; 19:101-5. [DOI: 10.1097/sle.0b013e31819f32f5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lai SW, Liao KF, Lai HC, Chou CY, Cheng KC, Lai YM. The prevalence of gallbladder stones is higher among patients with chronic kidney disease in Taiwan. Medicine (Baltimore) 2009; 88:46-51. [PMID: 19352299 DOI: 10.1097/md.0b013e318194183f] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The pathogenesis of gallstone disease is multifactorial. Few studies have focused on gallbladder stones in the chronic kidney disease population in Taiwan. We conducted the current study to determine the prevalence of gallbladder stones in populations with and without chronic kidney disease.This was a hospital-based, cross-sectional study. We retrospectively analyzed the patients receiving periodic health examinations at 1 medical center in Taiwan from 2001 to 2004. In all, 4773 patients were enrolled in the study. Chronic kidney disease was defined as a glomerular filtration rate less than 60 mL/min per 1.73 m by the Modification of Diet in Renal Disease formula. Odds ratio (OR) and 95% confidence intervals (CI) were expressed using a multivariate logistic regression analysis.We studied 2686 men (56.3%) and 2087 women (43.7%). The mean age was 49.1 +/- 12.2 years (range, 20-87 yr). The prevalence of gallbladder stones was 13.1% in the group of patients with chronic kidney disease and 4.9% in the group of patients without chronic kidney disease (p < 0.001). After controlling for the other covariates, multivariate logistic regression analysis showed that increasing age (aged 40-64 yr vs. 20-39 yr, OR = 3.06, 95% CI = 1.81-5.15; and > or =65 yr vs. 20-39 yr, OR = 6.13, 95% CI = 3.42-10.98), chronic kidney disease (OR = 1.58, 95% CI = 1.01-2.47), body mass index > or =27 kg/m (OR = 1.39, 95% CI = 1.02-1.91), metabolic syndrome (OR = 1.45, 95% CI = 1.08-1.94), and cirrhosis (OR = 4.23, 95% CI = 1.25-14.29) were significantly related to gallbladder stone disease.The prevalence of gallbladder stones in patients with chronic kidney disease is significantly higher than in those without chronic kidney disease. Our findings suggest that increasing age, chronic kidney disease, body mass index > or =27 kg/m, metabolic syndrome, and cirrhosis are the related factors for gallbladder stone formation.
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Affiliation(s)
- Shih-Wei Lai
- From the Department of Family Medicine (SWL, KCC, YML) and Department of Internal Medicine (KFL, HCL, CYC), China Medical University Hospital, Taichung, Taiwan
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Pamuk GE, Umit H, Harmandar F, Yeşil N. Patients with iron deficiency anemia have an increased prevalence of gallstones. Ann Hematol 2008; 88:17-20. [PMID: 18679684 DOI: 10.1007/s00277-008-0557-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
We determined the frequency of gallstones (GS) in iron deficiency anemia (IDA) patients and evaluated factors that could affect GS formation-like lipid levels and gallbladder (GB) motilities of the patients. One hundred and eleven IDA patients (88 females, 23 males; median age, 42) and 81 healthy controls (68 females, 13 males; median age, 42) were included into our study. The clinical findings of all IDA patients were recorded down; biochemical values and body mass index (BMI) were determined; and abdominal ultrasonography was performed. In addition, GB emptying was monitored by ultrasound at 30-min intervals for 2 h after a mixed meal in randomly chosen, age-matched 25 IDA patients and 26 controls. Fasting volume (FV), residual volume (RV), and ejection fraction (EF) for all GBs were determined. The frequency of GS plus cholecystectomy was significantly higher in IDA patients (15 cases, 13.5%) than in the control group (five cases, 6.2%, p = 0.048). IDA patients with GS plus cholecystectomy were older than those without GS plus cholecystectomy (p < 0.001). FV and EF did not differ between IDA and control groups (p > 0.05). On the other hand, RV was significantly higher in IDA group than in controls (p = 0.035). The frequency of GS in IDA patients was significantly higher than in controls. The increased prevalence of GS in IDA might be explained with impaired GB motility.
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Affiliation(s)
- Gülsüm Emel Pamuk
- Division of Hematology, Trakya University Medical Faculty, Edirne, Turkey.
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12
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van Petersen AS, van der Pijl HW, Ringers J, Lemkes HH, de Fijter HW, Masclee AAM. Gallstone formation after pancreas and/or kidney transplantation: an analysis of risk factors. Clin Transplant 2007; 21:651-8. [PMID: 17845641 DOI: 10.1111/j.1399-0012.2007.00704.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Pancreas and kidney transplantation (SPK) is the treatment of choice for patients with type 1 diabetes mellitus and end-stage renal failure. Gallstones are common after SPK transplantation but little is known about the true incidence and etiology of gallstones in this group. We therefore evaluated the incidence of gallstones and the presence of transplant-related risk factors in patients after SPK and kidney transplantation alone (KTA). Data were evaluated of 56 consecutive patients who underwent SPK transplantation and compared the results with those of 91 consecutive nondiabetic patients who underwent KTA transplantation at the Leiden University Medical Center between 1987 and 1994. Of the 58 evaluable KTA patients, 20.7% developed gallstones during 7.7 yr of follow-up and in the SPK group 43.9% of the 41 evaluable patients developed gallstones during 7.1 yr of follow-up. Postoperative weight loss and cyclosporin A-related hepatotoxicity correlated with gallstone formation both in SPK and KTA patients. In addition, the duration of postoperative fasting and autonomic neuropathy correlated with gallstones in SPK patients. It is concluded that both in patients after SPK transplantation and in patients after KTA transplantation, the risk to develop gallstones is significantly increased. Physicians should be aware of the high incidence of gallstones in SPK recipients.
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Affiliation(s)
- Andre S van Petersen
- Department of Surgery, Leiden Univresity Medical Center, Leiden, The Netherlands
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13
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Barut I, Tarhan OR, Baykal B, Demir M, Celikbas B. Higher incidence of cholelithiasis in chronic renal failure patients with secondary hyperparathyroidism undergoing peritoneal dialysis. Ren Fail 2007; 29:453-7. [PMID: 17497468 DOI: 10.1080/08860220701260636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In this study, we endeavored to determine whether the incidence of cholelithiasis (CL) was increased in chronic renal failure (CRF) patients with secondary hyperparathyroidism on a peritoneal dialysis (PD) program. We also evaluated the factors that might have some influence on the development of CL. METHODS A total of 59 CRF patients undergoing PD were included in the study. We studied the following groups to determine whether parathyroid hormone (PTH) levels were increased in CRF-PD patients: twenty patients with secondary hyperparathyroidism (group 1) and 39 patients with normal PTH levels (group 2). PTH levels were maintained at three times the upper limit of normal. Biochemical parameters were obtained for each CRF-PD patient. All patients underwent abdominal ultrasonography to screen for the presence of cholelithiasis. For statistical analysis, chi2, t test, and logistic regression analysis were used; p < 0.05 was considered as significant. RESULTS We found an almost ten times higher incidence (25% vs. 2.6%) of CL in group 1 patients with statistical significance (p = 0.007). When the incidence of CL according to sex, creatinine, and PTH levels were considered, female gender, creatinine, and PTH levels were higher in group 1, which was also significant statistically. No significant relationship was detected between gallbladder stone formation and the other analyzed biochemical parameters. CONCLUSIONS We found that the incidence of CL in CRF-PD patients with secondary hyperparathyroidism was higher than CRF-PD patients with normal PTH levels. It was also detected that female gender, high creatinine levels, and elevated PTH levels might influence the development of CL in CRF-PD patients.
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Affiliation(s)
- Ibrahim Barut
- Department of General Surgery, Suleyman Demirel University, School of Medicine, Isparta, Turkey.
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Yeh CN, Chen MF, Jan YY. Laparoscopic cholecystectomy for 58 end stage renal disease patients. Surg Endosc 2005; 19:915-8. [PMID: 15868265 DOI: 10.1007/s00464-004-2207-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2004] [Accepted: 12/14/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Since 1987, laparoscopic cholecystectomy (LC) has been widely used as the favored treatment for gallbladder lesions throughout the world. Because hemorrhage, infection, and delayed wound healing are the main causes of death after surgery for end-stage renal disease (ESRD), laparoscopic surgery is risky for ESRD patients. However, no information has been reported on such patients, so this study aimed to assess the safety of LC in ESRD patients. METHOD From January 1994 to December 2003, the medical records of 58 ESRD patients under regular hemodialysis (HD) with gallbladder lesions undergoing LC were reviewed (ESRD-LC). The clinical features and outcomes of 6,182 patients with gallbladder lesions without ESRD undergoing LC were also summarized for comparison. RESULTS Of 6,240 patients with gallbladder lesions undergoing LC, 58 (0.93%) had ESRD with regular HD. The ESRD-LC group clearly exhibited older age, higher frequency of associated disease, lower hemoglobin and platelet count, and elevated alkaline phosphatase, blood urea nitrogen, and creatinine values. However, only a higher frequency of high American Society of Anesthesiologists (ASA) grade and elevated creatinine value could differentiate ESRD-LC and LC patients by multivariate analysis. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were noted for the two groups. CONCLUSIONS LC is safe for ESRD patients with gallbladder lesions. Only a higher frequency of high ASA grade and elevated creatinine value could differentiate ESRD-LC and LC patients. Similar blood loss, conversion rate, morbidity, mortality, and hospital stay were achieved by applying LC to treat ESRD patients. However, appropriate preoperative preparations and experienced operative techniques are still required to prevent mortality.
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Affiliation(s)
- C-N Yeh
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan
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