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Prevalence of Gallstone Diseasein Hemodialysis Patients

1998; Volume: 78; Issue: 3 Linguagem: Inglês

10.1159/000044952

2235-3186

Şükrü Dumlu, Musa Bali, Murat Yılmaz, Şükrü Sindel, Turgay Arınsoy, Candan Tunçer, Enver Hasanoğlu,

Pancreatitis Pathology and Treatment

Dear Sir,Cholelithiasis is one of the major causes of morbidity in adults [1]. In Western countries, cholesterol is the principal constituent of gallstones. The most frequent causes of cholethiasis are gallbladder dysfunction, high bilirubin concentrations, infections, middle age, male gender, use of estrogens, obesity, and dietary factors [1]. Among chronic hemodialysis (HD) patients dietary changes and high bile cholesterol levels and high biliary saturation indexes may be responsible for an increased occurrence of gallstones [2].In December 1995, 50 HD patients were studied who had been on dialysis for at least 6 months, two to three times per week. The etiology of renal failure for 7 patients was amyloidosis, for 6 diabetes mellitus, for 5 malignant hypertension, for 1 systemic lupus erythematosus, and for 31 chronic glomerulonephritis. The risk factors for cholelithiasis and the patient characteristics are shown in table 1.All patients underwent full history, physical examination, biochemical and microbiological tests, ultrasound abdominal scanning, and patients with gallstones had standard cholecystography. Standard automated analyzers were used to assess renal function, liver enzymes, triglycerides, total and high- and low-density lipoprotein cholesterols, and complete blood counts. Statistical analysis was performed using the chi-square test with Yates' correction and the Student's t test.In 6 patients (12%) gallstones were found by ultrasound. None of the patients with gallstones had complaints. In this study, multiple pregnancies were not a risk factor for cholelithiasis. The prevalence of gallstones was 13.6% in males and 10.6% in females. Of the 6 patients with gallstones, 4 underwent standard cholecystography because 1 patient had the risk of repeated hypoglycemia, and 1 patient died after the ultrasound examination. In 3 patients who had undergone cholecystography gallstones were present.In this study, we found gallstones in 12% of 50 patients. This prevalence is higher than in the South Anatolia population where it was found to be 5.1%, but the difference was not statistically significant [3]. In Europe the prevalence of gallstones is 8–11% in the healthy population [4]. We could not find a relationship between gallstones and HD duration and frequency. Patients with chronic renal failure and patients on chronic HD treatment are at risk of developing gallstones because they have high bile cholesterol levels, high biliary saturation indexes and secondary hyperparathyroidism. In this study, of 9 patients with high serum parathyroid hormone levels, only 1 patient had gallstones and we could not find a relationship between a high level of parathyroid hormone and the prevalence of gallstones. As in the nondialyzed population, older age was found to be an important risk factor for cholelithiasis, but in our study there was no relationship between age and gallstone formation. In 1995 Bodomonti et al. [5] demonstrated a high prevalence (28%) of gallstones in patients who had chronic renal failure and were on a HD program. These authors claimed that a still undefined mechanism underlying the preexisting renal disease may be involved in the pathogenesis of this disease. In 1995 Paydaş et al. [6] demonstrated an 8% prevalence of gallstones in HD patients in South Anatolia in Turkey. In a study from Israel [4], a rate of cholelithiasis similar to that of the general population was found. In 1990 Moreckova et al. [2] demonstrated that patients on HD treatment have an increased bile cholesterol level and an increased saturation index of the bile, and that these changes became worse when a low-protein diet was given. The reason for such changes in the bile composition of 50 patients with end-stage renal disease remains obscure. In this study, we found a prevalence of gallstones of 12% in patients with chronic renal failure on HD treatment, and none of the cases had complained of the condition. Statistically we did not find a significant relationship between gallstones and chronic renal failure on HD patients. Despite the changes in the bile saturation index, dietary changes may have increased the gallstone formation in end-stage renal disease patients [2].