Aim: To study the functional dyspepsia in chronic hemodialysis patients of CNHU-HKM of Cotonou. Methods: This descriptive, analytical and cross-sectional study ran from 1 September 2013 to 28 February 2014 in the University Clinic of Nephrology Dialysis of CNHU-HKM of Cotonou. It included all chronic renal failure patients on hemodialysis for at least 9 months prior to the survey. After identifying the patients with upper gastrointestinal disorders, we had submitted to clinical Rome III criteria for functional dyspepsia. Upper endoscopy was performed in patients with clinical criteria of functional dyspepsia. Clinical factors associated, paraclinical and therapeutic were sought by logistic regression in univariate analysis. Data were analyzed using EPI DATA version 3.1. Results: 1) One hundred and thirty-one haemodialysis patients had participated in the study (sex ratio: 1.5, average age 49.6 ± 12.4 years). 2) The prevalence was 71.8% for upper gastrointestinal disorders, 64.9% for dyspeptic syndrome and 1.5% for functional dyspepsia. 3) They were associated to clinical criteria of functional dyspepsia of Roma III, the presence of high blood pressure, hypocalcaemia, treatment with calcic inhibitors and iron supplementation. Conclusion: Functional dyspepsia is uncommon in hemodialysis. The search of an organic cause is imperative for every dyspepsia.
The dyspeptic complaint is a difficult syndrome to rigorously characterize every day. It encompasses indeed most of upper gastrointestinal symptoms such as pain or discomfort sitting in the epigastric region [
In the general population, dyspepsia is a reason of increasingly frequent consultation and iterative exploration. Its prevalence in the general population varies according to studies, probably in relation with the definition [
Two types of dyspepsia are distinguished as it is indicative of a disease (organic dyspepsia), or as it is an isolated symptom (functional dyspepsia) [
In chronic haemodialysis patients, the prevalence of upper gastrointestinal complications is high. So it is 70.7% in Brunei (South east Asia) [
In Benin, functional dyspepsia represents 33.3% of patients referred for upper endoscopy [
To study functional dyspepsia in chronic hemodialysis of the National Teaching Hospital HKM of Cotonou.
1) To determine the prevalence of upper gastrointestinal disorders in chronic hemodialysis.
2) To determine the prevalence of dyspepsia in chronic hemodialysis.
3) To determine the prevalence of functional dyspepsia in chronic hemodialysis patients.
4) To identify factors associated with functional dyspepsia among chronic hemodialysis.
This study was conducted at National Teaching Hospital “Hubert K. MAGA” (CNHU-HKM) of Cotonou particularly in the University Clinic of Nephrology and Haemodialysis (UCNH). Upper gastrointestinal endoscopies were performed in the endoscopy unit at the Military Hospital of Cotonou (HIA/Cotonou).
This is a cross-sectional, descriptive and analytical study, which covered 6 months, from 1 September 2013 to 28 February 2014.
Were included, all patients with chronic renal failure undergoing hemodialysis for at least nine (9) months prior to the survey. All patients unable to cooperate due to poor general condition (performance index of World Health Organisation greater than or equal to 2), and all patients who refused to participate in the study were excluded.
The diagnosis of functional dyspepsia was based on Roma III criteria [
The urea reduction ratio (URR) is computed as follows:
where BUN is the blood urea nitrogen concentration (BUN) and post-BUN refers to the end of dialysis treatment and pre-BUN to the start of the same dialysis treatment [
An upper gastrointestinal endoscopy was performed from dental arches to the second duodenum in all patients with clinical criteria of Roma III to eliminate an organic cause.
Patients were received individually on the day of hemodialysis. A verbal consent of all patients included in this study was obtained before. Blood samples were taken at the beginning of the hemodialysis session. This study was submitted for ethical approval before beginning. Data collected using a survey form was entered in the DATA EPI software version 3.1 and analyzed using STATA/IC11.0 software. The significance level was set at 5% confidence intervals were calculated to 95%.
During the study period, 132 hemodialysis patients had responded to our inclusion criteria. One (1) patient had refused to participate in the study for personal reasons. Thus, our study population was reduced to 131 patients.
The average age of the study population was 49.6 ± 12.4 years, with extremes of 19 and 80 years. The sex ratio was 1.5. Merchants and handicrafts were the most represented. All socio-demographic characteristics are presented in
The history of hypertension was predominantly found in 70.2% patients. Coffee consumption was observed in 33.6%. The distribution of patients according to history and lifestyle is found in
Iron consumption (123; 93.9%) was the most represented, and then came the calcium channel blockers (104; 79.4%) and the inhibitor of enzyme converting (75; 57.2%) (
Hypertension and diabetes mellitus predominate as showed in the
The length of times on dialysis of these 131 haemodialysis patients was less than 4 years in 32.8% of cases; and more than 10 years in 26.7% of cases. The distribution of the dialysis parameters is in
Number N = 131 | Percentage | |
---|---|---|
Age (years) | ||
<40 | 29 | 22.1 |
40 - 50 | 34 | 26.0 |
50 - 60 | 37 | 28.2 |
≥60 | 31 | 23.7 |
Sex | ||
Male | 78 | 59.5 |
Female | 53 | 40.5 |
Profession | ||
Merchant, handicraft | 54 | 41.2 |
Teacher, engineer | 28 | 21.4 |
FSP, office agent | 18 | 13.7 |
Unemployed | 15 | 11.4 |
Other | 16 | 12.2 |
Marital status | ||
Live in couple | 104 | 79.4 |
Live alone | 27 | 20.6 |
Frequency | Percentage | |
---|---|---|
Antecedents | ||
Hypertension | 92 | 70.2 |
Hepatitis C | 23 | 17.6 |
Diabetes | 15 | 11.5 |
UGD* confirmed | 10 | 7.6 |
Chronic Glomerular-Nephritis | 8 | 6.1 |
Hepatitis B | 8 | 6.1 |
HIV** | 5 | 3.8 |
Digestive tract cancer | 0 | 0.0 |
Lifestyle | ||
Coffee consumption | 44 | 33.6 |
NSAI*** taking | 25 | 19.1 |
Alcohol consumption | 21 | 16.0 |
Cigarette smoking | 8 | 6.1 |
*Ulcer gastroduodenal; **Human immunodeficiency virus; ***Nonsteroidal anti-in- flammatory.
Frequency | Percentage | |
---|---|---|
Inhibitor of enzyme converting | 75 | 57.2 |
Calcium channel blockers | 104 | 79.4 |
Iron supplementation | 123 | 93.9 |
Frequency | Percentage | |
---|---|---|
Length of time on dialysis (year) | ||
Less than 4 | 43 | 32.8 |
4 - 6 | 35 | 26.7 |
6 - 10 | 18 | 13.8 |
10 et plus | 35 | 26.7 |
Number of weekly sessions | ||
Two sessions | 122 | 85.5 |
Three sessions | 19 | 14.5 |
Duration of each session | ||
Four hours | 29 | 22.1 |
Five hours | 102 | 77.9 |
Type vascular access | ||
Arteriovenous fistula | 121 | 92.4 |
Catheter | 10 | 7.6 |
Urea reduction rate | ||
<60% | 10 | 7.6 |
≥60% | 121 | 92.4 |
Of the 131 hemodialysis patients, 94% or 71.8% had at least one upper gastrointestinal symptom. The most common were belching (55 patients; 42.0%), dry mouth syndrome (33 patients; 25.2%), dysgeusia (27 patients; 20.6%) and epigastric pain (26 patients; 19.8%) (
Eighty-five (85) patients had dyspepsia during the investigation, the prevalence of dyspepsia is 64.9% (
Frequency | Percentage | |
---|---|---|
Belching | 55 | 42.0 |
Dry mouth syndrome | 33 | 25.2 |
Dysgeusia | 27 | 20.6 |
Epigastric pain | 26 | 19.8 |
Abdominal discomfort | 21 | 16.0 |
Anorexia | 21 | 16.0 |
Heartburn | 20 | 15.3 |
Nausea | 19 | 14.5 |
Stomach fullness | 13 | 9.9 |
Early satiety | 11 | 8.4 |
Vomiting | 11 | 8.4 |
Gastric distension sensation | 10 | 7.6 |
Hematemesis | 4 | 3.1 |
Metallic taste sensation | 1 | 0.8 |
Twenty (20) patients met the clinical criteria of Roma III where the achievement of upper gastrointestinal endoscopy was required. Two patients had refused to do this endoscopy. Of the remaining 18, two (2) patients had no lesion objectified in upper gastrointestinal endoscopy at the time of the survey, a prevalence of functional dyspepsia is 1.5% (2/131) as showed the
Associated factors were sought in the twenty (20) patients meeting the clinical criteria for functional dyspepsia Roma III.
Among the history, only hypertension was associated with clinical functional dyspepsia. Patients treated with calcium channel blockers had about six (6) times the risk of having clinical criteria of functional dyspepsia than those not taking. On the contrary iron consumption is a protective factor against the occurrence of clinical criteria of functional dyspepsia (OR = 0.83 < 1). Normal calcemia had an protective action (OR = 0.32). Associated factors are presented in
Frequency (n = 20) | Percentage | |
---|---|---|
Functional dyspepsia (UGE* normal) | 2 | 1.5 |
Antral erosive gastropathy or congestive | 9 | 6.9 |
Bulbar ulcer | 3 | 2.3 |
Antral ulcer | 2 | 1.5 |
Gastropathy and squamous fundic | 1 | 0.8 |
Ulcerative and antral burgeoning Neoformation | 1 | 0.8 |
UGE* refusal | 2 | 1.5 |
*Upper gastrointestinal endoscopy.
Functional dyspepsia n (%) | no functional Dyspepsia n (%) | RC [IC95%] | p | |
---|---|---|---|---|
ATCD* of hypertension | 0.02 | |||
NO | 2(5.1) | 37(94.9) | 1 | |
YES | 18(19.6) | 74(80.4) | 4.50 [0.99 - 20.43] | |
CCB** | 0.03 | |||
NO | 1(3.7) | 26(96.3) | 1 | |
YES | 19(18.3) | 85(81.7) | 5.81 [0.09 - 45.52] | |
Iron supplementation | <0.01 | |||
NO | 5(62.5) | 3(37.5) | 1 | |
YES | 15(12.2) | 108(87.8) | 0.83 [0.01 - 0.38] | |
Serum of calcium | 0.02 | |||
Hypocalcemia | 13(23.6) | 42(76.4) | 1 | |
Normal (95 - 105 mg/L) | 7(9.2) | 69(90.8) | 0.32 [0.12 - 0.88] |
*History of hypertension; **Calcium channel blockers.
No factor of socio-demographic, lifestyle, etiology of chronic renal failure and hemodialysis parameters was associated with clinical functional dyspepsia. Non-associated factors are presented in
Ninety-four (94) patients had at least one of the digestive symptoms above, a prevalence of 71.8%. This result is similar to that found in hemodialysis at Brunei. Indeed in a population of 123 hemodialysis Chong had found that 65.0% had at least one upper gastrointestinal symptoms [
Eighty-five (85) hemodialysis patients had dyspepsia ether a prevalence of 64.9%. These results are below those found in the population of patients referred for upper endoscopy realization of Cotonou. In effect SOSSA and collaborators in 2007 had found a prevalence of 77.9% among patients came for endoscopy [
Functional dyspepsia n (%) | No functional Dyspepsia n (%) | RC [IC95%] | p | |
---|---|---|---|---|
Age (year) | 0.07 | |||
Less than 40 | 4(13.8) | 25(86.2) | 1 | |
40 - 50 | 8(23.5) | 26(76.5) | 1.92 [0.51 - 7.20] | |
50 - 60 | 7(18.9) | 30(81.1) | 1.45 [0.38 - 5.56] | |
60 et plus | 1(3.2) | 30(96.8) | 0.20 [0.02 - 1.98] | |
Sex | 0.05 | |||
Male | 8(10.3) | 70(89.7) | 1 | |
Female | 12(22.6) | 41(77.4) | 2.56 [0.96 - 6.78] | |
Profession | 0.10 | |||
Merchant | 8(25.0) | 24(75.0) | 1 | |
Other | 7(19.4) | 29(80.6) | 0.72 [0.23 - 2.28] | |
Housewife | 4(33.3) | 8(66.7) | 1.50 [0.35 - 6.34] | |
Handicraft | 1(4.6) | 21(95.4) | 0.14 [0.01 - 1.23] | |
Teacher | 0(0.0) | 20(100) | - | |
PSF* | 0(0.0) | 9(100) | - | |
Marital status | 0.10 | |||
Live alone | 7(25.9) | 20(74.1) | 1 | |
Live in couple | 13(12.5) | 91(87.5) | 0.40 [0.14 - 1.15] | |
AINS taking | 0.19 | |||
NON | 14(13.2) | 92(86.8) | 1 | |
OUI | 6(24.0) | 19(76.0) | 2.07 [0.70 - 6.08] | |
Alcohol taking | 0.60 | |||
NO | 16(14.6) | 94(85.4) | 1 | |
YES | 4(19.0) | 17(80.9) | 1.38 [0.41 - 4.64] | |
Coffee taking | 0.24 | |||
NO | 11(12.6) | 76(87.4) | 1 | |
Yes | 9(20.5) | 35(20.5) | 1.77 [0.67 - 4.67] | |
URR** | 0.19 | |||
Less than 60 | 1(10.0) | 9(90.0) | 1 | |
60 and more | 19(15.7) | 102(84.3) | 0.51 [0.19 - 1.37] |
*Public security forces; **Urea reduction rate.
This prevalence found in our study is relatively above that found by some authors. In Morocco, Elhoussni et al. in 2011, found a prevalence of 58.0% of dyspepsia in chronic hemodialysis Rabat [
The prevalence of functional dyspepsia in our study population was 1.5%. This prevalence is well below that found in 2007 in general population who came for endoscopy in Cotonou (Benin) 33.3% [
Hypertensive hemodialysis patients were 4.5 times more likely to present the clinical criteria of functional dyspepsia than non-hypertensive hemodialysis (OR [95% CI]: 4.50 [0.99 to 20.43]; p = 0.02). In opposite BACCI and collaborators in their series had not established a statistically significant relationship between hypertension and functional dyspepsia [
Consumption of calcium channel blockers was associated with clinical criteria of functional dyspepsia (5.81 [0.09 to 45.52]; p = 0.03). Patients who consumed calcium channel blockers had about six (6) times the risk of developing clinical criteria of functional dyspepsia than those who did not consume. Indeed calcium channel blockers have the mode of action to prevent the intracellular penetration of calcium in skeletal muscle but also in smooth muscle fibers. Or intracellular calcium is the activator of muscle contraction [
Iron consumption mean while, was also associated with clinical criteria of functional dyspepsia as a protective factor (0.83 [0.01 to 0.38]; p < 0.01). Indeed, according to the literature, iron consumption is the cause of irritation of the digestive tract and thus represent an organic cause of dyspepsia [
Consumption converting enzyme inhibitor is not associated with the occurrence of clinical criteria of functional dyspepsia (1.14 [0.43 to 3.01]; p = 0.78).
Normal calcemia had a protective action against clinical criteria of functional dyspepsia (0.32 [0.12 - 10.99]; p = 0.02). This could be explained by the fact that calcium is involved in neuromuscular excitability. Hypocalcaemia could therefore be obvious clinically by neuromuscular and sensory signs such paraesthesia, hypoesthesia, muscle spasms disrupting gastric motility [
Clinical criteria of functional dyspepsia were showed in all age groups in our study, there was no significant association between age and clinical functional dyspepsia. Bacci et al. in opposite found a significant association between the occurrence of functional dyspepsia and age of their patients. Indeed they had observed that more patients are young, more the risk of occurrence of functional dyspepsia seems present [
Sex is not associated with the occurrence of clinical functional dyspepsia in our study (p = 0.05). The same observations were made by SOSSA and collaborators (p = 0.05) [
The profession of our patients was not associated with clinical functional dyspepsia (p = 0.10). This is a variable that is rarely taken into account in the different studies.
The anti-inflammatory intake was not associated with clinical functional dyspepsia (2.07 [0.70 to 6.08]; p = 0.19). Bradette reveals that certain medications such as anti-inflammatory play an important role in the development of dyspepsia [
Alcohol consumption was not associated with clinical functional dyspepsia (1.08 [0.41 - 4.64]; p = 0.60). The same observations were made by Bacci et al. (p = 0.40) [
Coffee consumption was not associated with the occurrence of clinical functional dyspepsia (1.77 [0.67 to 4.67]; p = 0.24). Coffee consumption is rarely taken into account as variable in studies.
No statistically significant association was found between the etiology of chronic kidney disease and clinical functional dyspepsia signs. In the literature, no correlation was observed between the etiology of renal disease and the occurrence of functional dyspepsia [
A statistically significant association was not found between the length of time on dialysis and clinical functional dyspepsia (p = 0.50). Salles Junior et al. had also found no link between seniority dialysis and dyspepsia (p = 0.87) [
The urea reduction rate was not significantly associated with the occurred of clinical functional dyspepsia. The literature provides more data of the Kt/V parameter. Indeed Salles Junior et al. and Altay et al. have found that the Kt/V was not significantly associated with the onset of dyspepsia [
The prevalence of dyspepsia is 64.9% in hemodialysis patients of the National Teaching Hospital “HKM” of Cotonou and of functional dyspepsia according to Rome III diagnostic criteria which is 1.5%. Factors associated with clinical criteria of functional dyspepsia are: history of hypertension, treatment with calcium channel blockers, iron supplementation and calcemia.
This low prevalence of functional dyspepsia suggests an active search for an organic cause by the realization of aoeso-gastro-duodenal endoscopy in these patients.
None.