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Outcomes in Patients With End Stage Renal Disease and Colonic Diverticular Disease
Heather L Yeo, Louis Salamone, Marc Lorber, Walter Longo
Yale University School of Medicine, New Haven, CT
Objective: To evaluate outcome in patients with end-stage renal disease(ESRD) and symptomatic colonic diverticular disease
Design: Patient cohort study
Setting: University Hospital
Interventions: N/A
Patients: 77 patients with were identified with both ESRD and symptomatic colonic diverticular disease at Yale-New Haven Hospital from January 1,1985 to December 31,2005.
Main Outcome Measures: Patients were evaluated to determine spectrum of disease, response to treatment and outcomes following therapy. Patient factors evaluated include age, gender, comorbidities, ESRD cause, type of diverticular disease, clinical presentation, management/treatment and outcome. Chi-square analysis was used to compare categorical data. Dependant variables were length-of-stay (LOS), complications, and mortality.
Results: Mean age was 70+/-13 years. Thirty-one/77 (40%) were male. Fifty-four/77 (70%) had diverticulosis. Thirty-three/54 (61%) presented with gastrointestinal hemorrhage. Twenty-eight/33 (88%) required transfusion. One/28(4%) required surgery; one/28 (4%) required angiographic embolization. There were no deaths. Twenty-five/77(30%) developed symptomatic diverticulitis. Sixteen/25 (60%) were uncomplicated. Fifteen/16 (93%) were managed conservatively; 1/16 (12%) required surgery. Nine/25 (36%) presented with complicated diverticulitis; three/9 (33%) with perforation and 2/9 (22%) with abscess. Eight/9 (88%) with complicated disease required urgent/emergent surgery. Five/9 (55%) who underwent surgery developed a perioperative complication. Four/9(16%) died following surgery. Risk-factors for death were female gender, diabetes, and perforation (p<0.05). Overall mean LOS for diverticular disease was 14.5+/-26 days.
Conclusions: The presentation of diverticular disease in ESRD patients differs from those with normal renal function. ESRD patients have higher rates of diverticular bleeding requiring transfusion. Patients with ESRD who develop diverticulitis frequently present with complicated disease, requiring surgery. Those that require surgery for diverticulitis have a high mortality. Those with uncomplicated disease can be successfully managed conservatively. ESRD may adversely effect treatment of symptomatic diverticular disease.
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