Spectrum of Upper Gastrointestinal Endoscopic Findings in Patients With End-Stage Renal Disease Undergoing Maintenance Hemodialysis: A Single-Center Experience From Pakistan.

INTRODUCTION: Symptoms related to the upper gastrointestinal (GI) tract and bleeding complications are common presentations in patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis. Various factors, including uremia, platelet dysfunction, use of anticoagulation during hemodialysis, anemia, impaired GI motility, diabetes mellitus, and polypharmacy, can lead to a wide range of abnormalities. Local literature from Pakistan is scant. Therefore, the aim was to assess the spectrum of upper GI endoscopic findings in hemodialysis patients with ESRD. METHODS: After approval from the ethical review committee at the Sindh Institute of Urology and Transplantation (SIUT), this prospective, descriptive cross-sectional study was conducted at the Department of Hepatogastroenterology, SIUT, Pakistan, between January 2024 and December 2024. Patients aged 18-65 years suffering from ESRD receiving maintenance hemodialysis for at least three months who had undergone upper GI endoscopy for dyspepsia, vomiting, reflux, anemia, hematemesis, melena, or pre-transplant assessment were included. Data regarding demographics, co-morbidities, dialysis factors, endoscopic indications, lab investigations, drug exposure, and endoscopic findings were collected. RESULTS: A total of 150 patients participated in the study. The mean age was 47.8 ± 13.6 years, and among them, 92 (61.3%) were males. Diabetes mellitus was found in 64 (42.7%) patients, while hypertension was found in 126 (84%) patients. The most common reason for performing the endoscopy was dyspepsia or epigastric pain in 58 (38.7%) patients, followed by anemia of undetermined cause in 35 (23.3%), and upper GI bleed in 27 (18%) patients, respectively. Endoscopic abnormalities were noted in 126 (84%) patients. The most common finding was gastritis in 76 (50.7%) patients, followed by erosive gastropathy in 42 (28.0%), reflux esophagitis in 31 (20.7%), duodenitis in 28 (18.7%), gastric ulcers in 16 (10.7%), and duodenal ulcers in 11 (7.3%) patients, respectively. CONCLUSION: Upper GI lesions are common in patients with ESRD on hemodialysis therapy. The common abnormalities include gastritis, erosive gastropathy, esophagitis, duodenitis, and peptic ulcers. Endoscopic examination needs to be done early in patients with symptoms suggestive of upper GI problems. These findings support consideration of timely upper GI endoscopic evaluation in symptomatic patients with ESRD receiving maintenance hemodialysis.