Obscure gastrointestinal bleeding (OGIB) is one of the common complications in patients with chronic kidney disease (CKD), especially those who are on maintenance hemodialysis (HD). However, little is known about the characteristics of the small-bowel lesions in these patients, or of the factors that could predict the presence of such lesions. Therefore we enrolled a total of 42 CKD patients (including 19 HD patients and 23 non-HD patients), and compared the incidence of the small-bowel lesions among two groups. Furthermore, to identify predictive factors for the presence of small-bowel lesions, we performed multivariate logistic-regression-analyses. The incidence of small-bowel vascular lesions was significantly higher in CKD patients than in age-and-sex matched non-CKD patients ( ). On the other hand, there was any significant difference of the incidence of small-bowel lesions between HD and non-HD patients. In CKD patients, past history of blood transfusion (OR 5.66; 95% CI 1.10–29.1, ) was identified as an independent predictor of the presence of vascular lesions, and history of low-dose aspirin use (OR 6.00; 95% CI 1.13–31.9, ) was identified as that of erosive/ulcerated lesions. This indicated that proactive CE examination would be clinically meaningful for these patients. 1. Introduction The incidence of chronic kidney disease (CKD) and the number of patients requiring maintenance hemodialysis (HD) have continued to increase in developed countries [1]. Anemia is a common feature in CKD patients [2]. It is usually normocytic and normochromic because of the decreased erythropoiesis and red blood cell survival. However, these patients can also have concomitant iron deficiency anemia (IDA) caused by gastrointestinal bleeding. Gastrointestinal bleeding is more common in CKD patients than in the general population and is also associated with a higher mortality in these patients [3]. A higher incidence of bleeding from gastroduodenal ulcers has been reported in patients with end-stage renal disease [4]. In addition, the incidence of vascular lesions such as angioectasia has also been reported to be increased in these patients [5, 6]. These findings lend support to the hypothesis that CKD patients are at a higher risk of gastrointestinal bleeding, which in turn can result in IDA. However, upper and lower gastrointestinal endoscopies often do not reveal any obvious hemorrhagic lesions in these patients. Obscure gastrointestinal bleeding (OGIB) is defined as persistent or recurrent bleeding associated with negative findings on upper and lower
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