One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study).

Autor:	Wong G; Sydney School of Public Health, Faculty of Medicine and Health, germaine.wong@health.nsw.gov.au.; Centre for Transplant and Renal Research, and.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Hope RL; Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia., Howard K; Sydney School of Public Health, Faculty of Medicine and Health., Chapman JR; Centre for Transplant and Renal Research, and., Castells A; Gastroenterology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; and.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Spain., Roger SD; Department of Renal Medicine, Gosford Hospital, Gosford, Australia., Bourke MJ; Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia., Macaskill P; Sydney School of Public Health, Faculty of Medicine and Health., Turner R; Sydney School of Public Health, Faculty of Medicine and Health.; Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand., Williams G; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Lim WH; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia., Lok CE; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia., Diekmann F; Department of Nephrology and Kidney Transplantation, Clinical and Provincial Hospital of Barcelona, Barcelona, Spain., Cross NB; Department of Nephrology and Kidney Transplantation, Christchurch Hospital, Christchurch, New Zealand.; Department of Medicine, University of Otago, Christchurch, New Zealand., Sen S; Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia., Allen RDM; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia., Chadban SJ; Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.; Charles Perkins Centre, The University of Sydney, Sydney, Australia., Pollock CA; Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia., Tong A; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Teixeira-Pinto A; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Yang JYH; School of Mathematics and Statistics, and., Williams N; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Au EHK; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Kieu A; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., James L; Sydney School of Public Health, Faculty of Medicine and Health.; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia., Craig JC; College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2019 Jun; Vol. 30 (6), pp. 1061-1072. Date of Electronic Publication: 2019 Apr 30.
DOI:	10.1681/ASN.2018121232
Abstrakt:	Background: In patients with CKD, the risk of developing colorectal cancer is high and outcomes are poor. Screening using fecal immunochemical testing (FIT) is effective in reducing mortality from colorectal cancer, but performance characteristics of FIT in CKD are unknown. Methods: To determine the detection rates and performance characteristics of FIT for advanced colorectal neoplasia (ACN) in patients with CKD, we used FIT to prospectively screen patients aged 35-74 years with CKD (stages 3-5 CKD, dialysis, and renal transplant) from 11 sites in Australia, New Zealand, Canada, and Spain. All participants received clinical follow-up at 2 years. We used a two-step reference standard approach to estimate disease status. Results: Overall, 369 out of 1706 patients who completed FIT (21.6%) tested positive; 323 (87.5%) underwent colonoscopies. A total of 1553 (91.0%) completed follow-up; 82 (4.8%) had died and 71 (4.2%) were lost. The detection rate of ACN using FIT was 6.0% (5.6%, 7.4%, and 5.6% for stages 3-5 CKD, dialysis, and transplant). Sensitivity, specificity, and positive and negative predictive values of FIT for ACN were 0.90, 0.83, 0.30, and 0.99, respectively. Of participants who underwent colonoscopy, five (1.5%) experienced major colonoscopy-related complications, including bowel perforation and major bleeding. Conclusions: FIT appears to be an accurate screening test for patients with CKD, such that a negative test may rule out the diagnosis of colorectal cancer within 2 years. However, the risk of major complications from work-up colonoscopy are at least ten-fold higher than in the general population. (Copyright © 2019 by the American Society of Nephrology.)
Databáze:	MEDLINE
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