Gastrointestinal disease in end-stage renal disease

Table 1 Summary of the results of motility studies in patients with renal failure from 1985 to 2019

Ref.	Study population	Results
Freeman et al[24], 1985	Age: 29-67 years, 9 patients on pre-dialysis	No difference with liquid or solids between renal failure group and controls
Brown-Cartwright et al[25], 1988	10 patients with ESRD on CAPD, 15 controls	Delayed emptying in 5/10 patients with CAPD with dialysate, normal when dialysate removed. Excluded: Diabetics
Bird et al[26], 1994	20 CAPD (9/20 patients with diabetes), 8 controls	9/20 (4 diabetic and 5 non-diabetic) delayed solid emptying, among which 4 also had delayed liquid emptying
Fernström et al[27], 1999	30 CAPD, 160 healthy controls	Half emptying time was prolonged. Retention at 90 and 120 minutes were higher, and gastric emptying rate was slower in male patients with CAPD compared to male controls. No significant differences were found in postprandial egg.
Lin et al[23], 1997	24 symptomatic patients with CRF (age 28-83 years; 15/24 patients with diabetes), 12 asymptomatic controls (median age: 36)	Patients with CRF showed a significantly lower percentage of normal 2-4 cpm waves in both fasting and fed states. The prevalence of an abnormal response of the egg to the test meal (no increase or decrease in egg dominant power after the test meal) was significantly higher in patients with CRF. There was no statistical difference between diabetic and non-diabetic patients with CRF.
Lee et al[28], 2000	41 patients: 22 HD, 19 CAPD	There was no difference in the normal slow-wave frequency between patients on HD and CAPD. There was a significant correlation between changes in tachygastria after CAPD and grade of early satiety in patients on CAPD with UGI symptoms. Dialysis modalities seem to affect gastric myoelectrical activity differently in patients with ESRD. Excluded: Diabetics
Stompór et al[29], 2002	20 CAPD (mean age: 501 ± 11 years), no control group	Gastric emptying is markedly impaired in patients on CAPD compared to healthy subjects. However, the presence of dialysate does not influence it significantly.
Strid et al[30], 2004	39 CRF, 131 controls	Delayed gastric emptying is common in patients with chronic renal failure, particularly in men. The delay was not associated with the presence of GI symptoms, underlying renal disease or H. pylori infection. However, the dialytic status might have an impact on gastric emptying in patients with CRF. Excluded: Diabetics
Hubalewska et al[31], 2004	20 patients on CAPD (mean age: 50 ± 11 years), 15 controls	Gastric emptying in subjects with chronic renal failure treated with CAPD is markedly delayed compared to healthy subjects. There was no significant effect of indwelling dialysate in the peritoneal cavity on gastric emptying rates found, based on the observation that its removal was not associated with any noticeable improvement of gastric emptying. The data strongly contraindicate the theory of peritoneal dialysate volume being the cause of this reversible disorder and indicate that the role of other possible factors leading to the development of gastropathy in those patients should be investigated. Excluded: Diabetics
Hirako et al[32], 2005	21 patients with ESRD just diagnosed before initiation of dialysis (7/21 were patients with diabetes), 21 controls	Low hypogastria post prandial in CRF, high bradygastria in both fasting and postprandial states. Low power ratio in CRF, no difference between diabetic and non-diabetic. Delayed gastric emptying in CRF, no difference between diabetic and non-diabetic. Inverse correlation between normogastria and emptying. A significant relation between bradygastria and GI symptoms but no other association suggesting delayed motility may not explain the symptoms. The patients with CRF showed gastric hypomotility, including impaired gastric myoelectrical activity and delayed gastric emptying. Gastric hypomotility appears to be an important factor in the generation of GI symptoms in patients with CRF
Adachi et al[33], 2007	19 patients with CRF on HD, 12 controls	Eleven patients had normal gastric motor function and eight showed abnormalities of either gastric myoelectrical activity or gastric emptying. More than half of the patients with CRF on HD demonstrated normal gastric motility, and no or slight GI symptoms
Broberg et al[34], 2019	24 patients with ESRD on chronic HD (further divided into 3 groups: Normal glucose tolerance, impaired glucose tolerance, diabetics), 8 controls	Altered gastrointestinal motility in dialysis patients, with higher gastric retention and prolonged gastric emptying, and higher total AUC of GIP and glucagon independent of the presence of diabetes or prediabetes

AUC: Area under the receiver operating characteristic curve; CAPD: Continuous ambulatory peritoneal dialysis; CRF: Chronic renal failure; ESRD: End-stage renal disease; GI: Gastrointestinal; GIP: Glucose-dependent insulinotropic polypeptide; HD: Hemodialysis; UGI: Upper gastrointestinal.