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Journal of Investigative Medicine:
doi: 10.231/JIM.0b013e3182a67ba3
Original Articles

Use of Blood Tests to Predict Upper Gastrointestinal Lesions in Patients With Chronic Kidney Disease

Song, Youn Mi MD; Yoon, Hye Eun MD*; Choi, Yoo A. MD*; Kim, Eun Oh MD*; Lee, Sang Ju MD*; Chang, Yoon Kyung MD*; Kim, Suk Young MD*; Yang, Chul Woo MD*; Hwang, Hyeon Seok MD*

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Abstract

Objective

Anemia and iron deficiency are common complications in patients with chronic kidney disease (CKD). However, information about the diagnostic indicators of bleeding-related upper gastrointestinal (GI) tract lesions is sparse and few studies have investigated anemic upper GI tract lesions.

Methods

We included 165 anemic patients with non–dialysis-dependent CKD stages 3 to 5 (44 patients at stage 3, 52 patients at stage 4, and 69 patients at stage 5). Transferrin saturation (TSAT), serum ferritin, mean corpuscular volume, and corrected reticulocyte count data were collected to evaluate their diagnostic use for bleeding-related upper GI tract lesions, which were identified by esophagogastroduodenoscopy.

Results

Bleeding-related GI tract lesions were found in 57 patients (34.5%). The area under the receiver-operating characteristic curve used to predict bleeding-related lesions was 0.63 for TSAT (P = 0.007), and the best cutoff value was 19.7% (sensitivity, 0.53; specificity, 0.76). The combination of cutoffs TSAT less than 20% or serum ferritin less than 100 ng/mL produced a 17% increment in sensitivity compared with that of TSAT less than 20% alone. The corrected reticulocyte levels and mean corpuscular volume had no significant diagnostic use. In patients with CKD stage 5, the sensitivity of TSAT or its combination with serum ferritin less than 100 ng/mL was significantly lower than in patients with CKD stage 3 (all P < 0.05).

Conclusions

Transferrin saturation is a significant predictor of anemic lesions in the upper GI tract, and serum ferritin can increase the sensitivity of TSAT. However, these indicators should be used with caution in patients with CKD stage 5 because their sensitivity is poor in this context.

Copyright © 2013 by The American Federation for Medical Research

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