Prevalence of colorectal neoplasia in patients with chronic kidney disease undergoing colorectal cancer screening in a university teaching hospital / Dr. Mohd Hasnul Helmi Zulkifli

Introduction: Chronic kidney disease (CKD) is an independent risk factor for colorectal neoplasia and carcinoma. We aim to determine the prevalence of colorectal neoplasia and examine its associated factors in patients with CKD attending the nephrology clinic in Hospital UiTM.
Methodology: This was a cross--sectional single-centre study conducted in a university teaching hospital in Malaysia. The inclusion criteria are patients with CKD stages 3-5, age ≥ 50 years attending the nephrology clinic from December 2021 to May 2022. The exclusion criteria included a history of colorectal cancer, inflammatory bowel disease and first-degree relative with Colorectal Cancer (CRC). Recruited patients were screened with Faecal Immunochemical Test (FIT) and were scheduled for colonoscopy if the FIT was positive. The presence of colorectal neoplasia and its characteristics were recorded based on the endoscopic and histologic evaluation.
Results: Out of 168 subjects who fulfilled the inclusion criteria, the FIT-positive rate was 34.5% (n=58). Nine subjects who were FIT positive did not undergo colonoscopy, resulting in a final sample size of 159 subjects. The median (IQR) age was 66 (62-71) years. There was a male gender preponderance (66%) and most of the participants were of Malay ethnicity (93.7%). The CKD stage distribution were 45.3% (n=72) CKD 3; 34% (n=54) CKD 4; 8.8% (n=14) CKD 5 not on dialysis; and 11.9% (n=19) were on dialysis. Among those who underwent colonoscopy, the polyp detection rate was 69.4% (n=34) and the adenoma detection rate was 57.2% (n=28). There was one case of colorectal cancer. The prevalence of colorectal neoplasia in our cohort of CKD patients was 18.2%. Two or more polyps were found in 70.6% (n=24) of subjects. Adenoma ≥ 10mm in size was found in 23.5% (n=8) participants, with the largest measuring 20mm. In multivariate analysis, usage of oral anticoagulant was significantly associated with colorectal neoplasia (OR 10.24, 95% CI [1.78-58.97]) (p-value 0.009).
Conclusion: The prevalence of colorectal neoplasia in subjects with CKD was 18.2%. The usage of oral anticoagulant was a significant risk factor for colorectal neoplasia.