Small Intestinal Lesions in Patients with Anemia on Hemodialysis: A Two-Center, Cross-Sectional Study

Abstract

<b><i>Aim:</i></b> The number of patients on chronic dialysis in Japan is increasing every year, and the average age of these patients is also increasing annually. Iron deficiency is an important cause of anemia in patients on hemodialysis (HD). However, it has not been clarified whether these patients might have small intestinal mucosal lesions causing iron deficiency anemia. <b><i>Methods:</i></b> We conducted a cross-sectional study in ­asymptomatic patients on HD between April 2014 and ­December 2015. We performed small bowel capsule endoscopy (SBCE) and analyzed the relationship between small intestinal endoscopic findings and anemia. <b><i>Results:</i></b> SBCE was successfully completed in 39 eligible patients. Univariate analysis revealed that there was a significant difference in blood hemoglobin levels between the morbid SBCE-finding group (median 7.7 g/dL; range 6.7–9.2 g/dL) and the non-morbid SBCE-finding group (median 10.65 g/dL; range 6.4–13.1 g/dL; <i>p</i> = 0.0006, Mann-Whitney U test). On multivariate analysis, the blood hemoglobin level was an independent predictor of morbid SBCE findings (<i>p</i> = 0.0033). The cutoff value of blood hemoglobin level for the morbid SBCE finding was determined as 9.2 g/dL using receiver operating characteristic curve analysis. <b><i>Conclusions:</i></b> Patients on HD with anemia are at a high risk of small intestinal lesions. Since the control of small intestinal lesion may improve the anemia, these outcomes are significant factors for managing patients on HD.