POS-338 GASTRO-INTESTINAL ANGIODYSPLASIA IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Abstract

Angiodysplasia is an abnormal, dilated small blood vessel in the mucosal and submucosal layers of the gastrointestinal (GI) tract. It’s responsible for approximately 6% of lower GI bleeding cases and up to 8% of upper GI bleeds. Besides, it has been reported to be associated more with some pathologies, among others, end-stage chronic kidney disease (CKD). Yet under diagnosed because of current anemia and GI bleeding in patients with CKD, which present the main symptoms of angiodysplasia. We looked into our department’s database from 2007 till 2020. We registered 7 confirmed cases among our patients with angiodysplasia at end-stage renal disease. One of them was excluded because of partial damage of his record. We conducted a retrospective study on the rest of the cases. The clinical features, risk factors and prognosis were evaluated. The prevalence of angiodysplasia across all the periods studied was higher in males than in female (5 cases vs 1) with a mean age of 60.7 years. The majority of patients were tobacco smokers (4 patients), had hypertension (5 patients), and other cardiovascular diseases (4 patients), but only one among those six presented a coexistent aortic valve disease. In all cases angiodysplasia was diagnosed at end-stage CKD on the occasion of a low GI bleed either simultaneously with the diagnosis of end-stage CKD (half cases) or during the first six months of hemodialysis (the other half) . No specific association was established between this pathology and the nephropathy leading to renal failure. However, the association with other causes of GI bleeding found in 3 cases (anticoagulant overdose, ischemic colitis, Stomach ulcers) detained early treatment. Gastric localization (1 case) had the best prognosis while the rest of patients with intestinal and ileocolic angiodysplasia presented recurrence of bleeding and required further treatment: argon plasma coagulation and total colectomy (1 case); embolization (2 cases). Yet the mortality is estimated at 3 per 6 in the 6th month of evolution and reached 5 of them at the 12th month. Gastrointestinal bleeding in end-stage renal disease patients require further awareness because of frequent association with angiodysplasia usually underdiagnosed. Advanced age, overall high comorbidity and hypertension; commonly present at the end-stage CKD; are significant factors for angiodysplasia-associated gastrointestinal bleeding. Besides, dialysis seems increasing the prevalence of abnormal vessel bleeding and leads to a high risk of mortality.