MO558: Chronic Kidney Disease and Gastroparesis: What is the Association?

Abstract

Abstract BACKGROUND AND AIMS Chronic kidney disease (CKD) can predispose individuals to multiple extrarenal manifestations, such as anemia, bone disease, heart disease and electrolyte disorders. In addition, some patients with CKD can present with gastrointestinal (GI) symptoms, but the pathogenesis of this condition is still unclear. Symptoms of gastroparesis include early satiety, pyrosis, epigastric pain, nausea and vomiting, which may lead to caloric and electrolyte deficiencies as well as significant weight loss. Therefore, the aim of this study was to analyze the association between CKD and gastroparesis. METHOD A systematic literature review was conducted following the PRISMA guidelines. Papers were selected searching PubMed/Medline, SciELO and LILACS databases using the terms (chronic kidney disease OR CKD) and (gastroparesis OR gastric emptying) in January 2022. The inclusion criterion was limited to observational studies that evaluated the association between CKD and gastroparesis. There were no language or publication date restrictions. RESULTS Among the 111 papers initially identified, 14 were eligible for this review after full texts were read. Dysmotility-like dyspeptic complaints and delayed gastric emptying can be prevalent in CKD patients. Gastric hypomotility appears to be an important factor in the generation of GI symptoms in patients with CKD. Different pathophysiological mechanisms, such as electrolyte imbalance, gastric mucosal edema and direct toxicity of uremic retention molecules can play a role in inducing gastroparesis in patients with CKD. Serum levels of several polypeptide hormones involved in the modulation of GI motility [e.g. gastrin, cholecystokinin (CCK) and neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) were significantly altered as a consequence of renal insufficiency and may play a major role in gastrointestinal dysmotility. Patients with CKD showed impaired gastric myoelectrical activity in response to food and high levels of GI hormones. Delayed gastric emptying contributes to malnutrition, which may potentially have a broad impact in the prevention and treatment of CKD and its complications. Gastric emptying tests are valuable in identifying occult gastroparesis in high-risk patients and may guide the selection of prokinetic therapy, which can significantly increase levels of serum albumin and improve general prognosis. Electrogastrography is an interesting noninvasive technique to evaluate gastric motility in patients with severe chronic renal failure. CONCLUSION The studies suggest that patients with CKD are at higher risk of developing gastroparesis and dysmotility-like dyspeptic complaints. Nevertheless, more studies are needed to provide high-quality evidence.