Is There a Difference in the Prevalence of Gastroesophageal Reflux Disease between Peritoneal Dialysis and Hemodialysis Patients?

Hyun Jung Song; Sun Moon Kim; Yu Mi Lee; Jung Ah Hwang; Kyung Min Moon; Chang Gi Moon; Hoon Sup Koo; Kyung Ho Song; Yong Seok Kim; Tae Hee Lee; Kyu Chan Huh; Young Woo Choi; Young Woo Kang; Won Min Hwang; Sung Ro Yun

doi:10.4166/kjg.2013.62.4.206

Journal List > Korean J Gastroenterol > v.62(4) > 1007143

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Song, Kim, Lee, Hwang, Moon, Moon, Koo, Song, Kim, Lee, Huh, Choi, Kang, Hwang, and Yun: Is There a Difference in the Prevalence of Gastroesophageal Reflux Disease between Peritoneal Dialysis and Hemodialysis Patients?

Original Article

Korean J Gastroenterol 2013;62(4):206-212.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.206

Is There a Difference in the Prevalence of Gastroesophageal Reflux Disease between Peritoneal Dialysis and Hemodialysis Patients?

Hyun Jung Song, Sun Moon Kim, Yu Mi Lee, Jung Ah Hwang, Kyung Min Moon, Chang Gi Moon, Hoon Sup Koo, Kyung Ho Song, Yong Seok Kim, Tae Hee Lee, Kyu Chan Huh, Young Woo Choi, Young Woo Kang, Won Min Hwang, Sung Ro Yun

Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea

Correspondence to: Sun Moon Kim, Department of Internal Medicine, Konyang University Hospital, 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-812, Korea. Tel: +82-42-600-9370, Fax: +82-42-600-9095, E-mail: ismkim@kyuh.ac.kr

Received 28 May 2013 Revised 22 July 2013 Accepted 22 July 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Gastroesophageal reflux disease (GERD) is a common upper gastrointestinal disorder in patients with chronic kidney disease (CKD). However, little is known about the prevalence of GERD in dialysis patients. The aim of the present study was to investigate the difference in the prevalence of GERD in peritoneal dialysis and hemodialysis patients.

Methods

From July 2010 to August 2011, peritoneal dialysis patients (n=30) and hemodialysis patients (n=38) were enrolled. The prevalences of GERD were assessed at a single center with endoscopic findings and interviews using a questionnaire. Also, risk factors of GERD were evaluated.

Results

The prevalences of GERD in peritoneal dialysis and hemodialysis patients were 33.3% and 39.5% (p=0.748), respectively. The prevalences of erosive reflux esophagitis (ERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 23.7% (p=0.477), respectively. The prevalences of nonerosive reflux disease (NERD) in peritoneal dialysis and hemodialysis patients were 16.7% and 13.2% (p=0.685), respectively. The prevalences of GERD, ERD and NERD were higher than those of the general population. The risk factor for GERD was age in hemodialysis patients.

Conclusions

The prevalence of GERD in dialysis patients was higher than that in the general population. However, there was no significant difference between peritoneal dialysis and hemodialysis patients.

Keywords: Gastroesophageal reflux, Peritoneal dialysis, Renal dialysis, Chronic kidney failure

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Fig. 1.

Prevalences of gastroesophageal reflux disease (GERD), erosive reflux esophagitis (ERD) and nonerosive reflux disease (NERD). PD, peritoneal dialysis; HD, hemodialysis. The general population data from a nationwide multicenter prospective study in Korea abstracted from the article of Kim et al.⁸

Table 1.

Clinical Characteristics

Characteristic	PD (n=30)	HD (n=38)	p-value
Age (yr)	55.0±11.6	57.0±9.9	0.445
Sex (male/female)	17/13	17/21	0.329
BMI (kg/m²)	24.6±3.6	24.0±4.1	0.110
Smoking	0 (0)	1 (2.6)	0.383
Alcohol	0 (0)	0 (0)
Etiology of ESRD
Diabetic nephropathy	12 (40.0)	23 (60.5)	0.327
Hypertensive nephropathy	11 (36.7)	9 (23.7)
Glomerulonephritis	4 (13.3)	1 (2.6)
Polycystic kidney disease	1 (3.3)	1 (2.6)
Other etiologies	2 (6.7)	1 (2.6)
Unknown	0	3 (7.9)
Duration of dialysis (mo)	61.1±42.2	70.5±50.9	0.417
Endoscopic diagnosis
Erosive reflux esophagitis	5 (16.7)	9 (23.7)	0.477
Hiatal hernia	5 (16.7)	3 (7.9)	0.265
Erosive gastritis	15 (50.0)	18 (47.4)	0.567
Hemorrhagic gastritis	6 (20.0)	8 (21.1)	1.000
Gastric ulcer	3 (10.0)	5 (13.2)	0.688
Gastric polyp	0 (0)	3 (7.9)	0.115
Gastric adenoma	0 (0)	2 (5.3)	0.202
Gastric cancer	0 (0)	0 (0)
Duodenal ulcer	2 (6.6)	3 (7.9)	0.394

Values are presented as mean±SD, n only, or n (%).

PD, peritoneal dialysis; HD, hemodialysis; ESRD, end stage renal disease.

Table 2.

Factors Associated with Gastroesophageal Reflux Disease in Dialysis Patients by Univariate Analysis

	GERD absent (n)	GERD present (n)	p-value	OR	95% CI
Age (yr)			0.027	4.965	1.20–20.49
≥65	8	10
＜65	35	15
Sex			0.465	0.637	0.19–2.14
Male	23	15
Female	20	10
History of smoking	1	0
BMI (kg/m²)			0.124	2.832	0.75–1.68
≥25	14	11
＜25	29	14
Calcium channel blocker	23	11	0.093	0.326	0.09–0.20
Nitrate	2	2	0.755	1.435	0.15–13.91
NSAIDs or aspirin	20	15	0.541	1.431	0.45–4.51
Diabetes	23	15	0.994	1.005	0.30–3.42
Helicobacter pylori			0.253	0.500	0.15–1.64
Positive	13	7
Negative	13	14

GERD, gastroesophageal reflux disease.

Table 3.

Factors Associated with Gastroesophageal Reflux Disease in Peritoneal Dialysis Patients by Univariate Analysis

	GERD absent (n)	GERD present (n)	p-value	OR	95% CI
Age (yr)			0.999	1.286	0.24–6.96
≥65	5	3
＜65	15	7
Sex			0.602	1.055	0.33–6.92
Male	12	5
Female	8	5
History of smoking	0	0
BMI (kg/m²)			0.122	4.333	0.85–22.23
≥25	7	7
＜25	13	3
Calcium channel blocker	12	4	0.442	0.444	0.09–2.09
Nitrate	2	1	0.999	1.000	0.08–12.56
NSAIDs or aspirin	6	4	0.690	1.556	0.32–7.60
Diabetes	9	5	0.796	1.222	0.27–5.59
Helicobacter pylori			0.197	0.238	0.33–1.71
Positive	6	2
Negative	5	7

GERD, gastroesophageal reflux disease.

Table 4.

Factors Associated with Gastroesophageal Reflux Disease in Hemodialysis Patients by Univariate Analysis

	GERD absent (n)	GERD present (n)	p-value	OR	95% CI
Age (yr)			0.030	5.833	1.20–28.37
≥65	3	7
＜65	20	8
Sex			0.254	2.182	0.57–8.41
Male	11	10
Female	12	5
History of smoking	1	0	0.413	1.000	0.08–12.56
BMI (kg/m²)			1.000	0.831	0.20–3.54
≥25	7	4
＜25	16	11
Calcium channel blocker	11	7	0.944	0.955	0.26–3.51
Nitrate	0	1	0.395	1.071	0.94–1.23
NSAIDs or aspirin	14	11	0.501	1.768	0.43–7.30
Diabetes	14	10	0.717	1.286	0.33–5.02
Helicobacter pylori			0.795	0.816	0.18–3.78
Positive	7	5
Negative	8	7

GERD, gastroesophageal reflux disease.

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