Lower Gastrointestinal Disorders Among Dialysis Patients

The prevalence of co-morbid gastrointestinal symptoms is high in dialysis patients, while abdominal pain, constipation, diarrhea, anorexia and abdominal bloating are the second-most common group of symptoms following dyspeptic symptoms. Underlying these symptoms is a wide spectrum of lower gastrointestinal disorders such as diverticular disease, angiodysplasia, mesenteric ischemia, ischemic colitis, colonic perforation, fecal impaction and stercoral ulcer, dialysis-related amyloidosis, encapsulating peritoneal sclerosis, and idiopathic dialysis ascites. Also, infarcts due to non-occlusive intestinal ischemia are less common but severe complications. Incidence of gastrointestinal disorders is considered to increase with the duration of renal failure, independent of dialysis modality. While uremia and dialysis have been linked to an increased risk of gastrointestinal tract lesions, pathogenesis of gastrointestinal dysfunction in end-stage renal disease is considered multifactorial and has not yet been clarified. In addition, conflicting data exist on the association of renal dysfunction with gastrointestinal disorders, and there are no explicit guidelines for the management of co-morbid gastrointestinal problems in patients with concomitant renal failure. Herein, we review the common lower gastrointestinal disorders that occur among dialysis patients, with an emphasis on prevalence, pathogenesis and diagnostic strategies.