Retrospective case-control study of the impact of dialysis on bowel preparation scores

Abstract

Background and study aims

Inadequate bowel preparation (BP) negatively affects diagnostic performance of colonoscopy. Most trials assessing adequacy of bowel preparation regimens have excluded patients affected by chronic kidney disease (CKD), especially patients on dialysis. This study aimed to assess the impact of dialysis on BP quality and adenoma detection rate (ADR) and identify factors related to quality of BP.

Patients and methods

We retrospectively compared patient-specific, preparation-specific (preparation solution, preparation regimen (split-dose vs. 1-day preparation, outpatient preparation), and colonoscopy-specific data (indication, Boston Bowel Preparation Score [BBPS], sedation type, presence of adenoma or cancer) between 79 patients on dialysis and 158 matched controls. Adequate BP was defined as a BBPS score ≧2 in every colonic segment. Significant contributors to BP were assessed by logistic regression.

Results

Despite matching, dialysis patients were significantly older (69.0 ± 11.9 vs 64.2 ± 14.6, P = 0.008) and less frequently women (30% vs 52%, P = 0.002). There was no significant difference in BP or ADR between patients on dialysis and controls (85% vs 89%, P = 0.39 and 35% vs 35%, P = 1.00, respectively). Older age (P = 0.03), lower body mass index (P = 0.03), type of BP regimen (P <0.001), outpatient preparation (P = 0.03), and residency in residential care (P = 0.05) were significantly associated with BP adequacy. According to the logistic regression model, split-dose regimen was the main predictor of adequate BP (P <0.001, odds ratio 3.1 [1.65–5.81]).

Conclusions

Safe and adequate BP is achievable in dialysis patients. Bowel preparation regimen rather than treatment with dialysis influences BP quality. Split-dose preparation remains the most important determinant of adequate BP for colonoscopy, irrespective of regimen.

Keywords

Endoscopy Lower GI Tract - CRC screening - Quality and logistical aspects - Preparation - Performance and complications

Publication History

Received: 24 October 2024

Accepted after revision: 11 March 2025

Accepted Manuscript online:
24 March 2025

Article published online:
12 May 2025

• References

• 1 Harewood GC, Sharma VK, de Garmo P. Impact of colonoscopy preparation quality on detection of suspected colonic neoplasia. Gastrointest Endosc 2003; 58: 76-79
• 2 Larsen M, Hills N, Terdiman J. The impact of the quality of colon preparation on follow-up colonoscopy recommendations. Am J Gastroenterol 2011; 106: 2058-2062
• 3 Lebwohl B, Kastrinos F, Glick M. et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc 2011; 73: 1207-1214
• 4 Kaminski MF, Thomas-Gibson S, Bugajski M. et al. Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative. United European Gastroenterol J 2017; 5: 309-334
• 5 Calderwood AH, Jacobson BC. Comprehensive validation of the Boston Bowel Preparation Scale. Gastrointest Endosc 2010; 72: 686-692
• 6 Hassan C, East J, Radaelli F. et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy 2019; 51: 775-794
• 7 Shahini E, Sinagra E, Vitello A. et al. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol 2023; 29: 1685-1707
• 8 Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2018; 30: 819-826
• 9 Saumoy M, Jesudian AB, Aden B. et al. High prevalence of colon adenomas in end-stage kidney disease patients on hemodialysis undergoing renal transplant evaluation. Clin Transplant 2016; 30: 256-262
• 10 Ohmiya N, Nakagawa Y, Horiguchi N. et al. Safety of polyethylene glycol solution plus ascorbic acid for bowel preparation for colonoscopy in patients with chronic kidney disease. Gastroenterol Res Pract 2021; 2021: 6696591
• 11 Clark BT, Protiva P, Nagar A. et al. Quantification of adequate bowel preparation for screening or surveillance colonoscopy in men. Gastroenterology 2016; 150: 396-405 quiz e314–395
• 12 Calderwood AH, Schroy 3rd PC, Lieberman DA. et al. Boston Bowel Preparation Scale scores provide a standardized definition of adequate for describing bowel cleanliness. Gastrointest Endosc 2014; 80: 269-276
• 13 Madi MY, Jaber F, Numan L. et al. Prevalence of colonic polyps in patients undergoing kidney transplant evaluation: A meta-analysis and systematic review. Exp Clin Transplant 2023; 21: 930-938