Comparative preoperative sonological assessment of gastric contents in patients with chronic kidney disease versus those with normal renal function - A prospective observational study

Abstract

Background and Aims: Though the role of fasting preoperative gastric ultrasound has been validated in different patient populations, namely, obese, pregnant and diabetics, it has not been explored in patients with chronic kidney disease (CKD). This prospective, observational study compared the fasting sonological assessment of gastric contents in patients with CKD versus those with normal renal function scheduled for elective surgery. Methods: After ethical approval and trial registration were obtained, preoperative gastric ultrasound was done in 115 CKD patients and 115 with normal renal function. Qualitative and quantitative assessment of residual gastric volume was done. Also, the patients were administered the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ) to evaluate gastroparesis objectively. The researcher was not blinded to the patient groups. Data analyses were done using the Statistical Package for Social Sciences (SPSS) for Windows software (version 22.0). Results: Gastric volumes exceeding 1.5 ml/kg or particulate or solid contents were found in 57 patients with CKD and 36 patients with normal renal function ( P = 0.004). The PADYQ scores were 6.54 ± 8.49 for CKD and 2.15 ± 5.71 for normal renal function ( P < 0.0001) groups. CKD patients had a higher age ( P < 0.001), lower body mass index ( P = 0.005) and higher incidence of diabetes mellitus ( P < 0.001). There were no incidents of gastric aspiration. Conclusion: Renal dysfunction contributes to delayed gastric emptying. PADYQ can also help identify those at high risk of gastroparesis. Combining the questionnaire and preoperative gastric ultrasound must be considered in these patients to ensure optimum safety.

Study on the occurrence and influencing factors of gastrointestinal symptoms in hemodialysis patients with uremia

“…With a delay in CKD management, the disease progresses and eventually develops into end-stage renal disease, also called uremia, requiring kidney transplantation or dialysis alternative therapies to maintain life[ 2 ]. The pathogenesis of uremia mainly involves the accumulation of urinary toxins such as urea, creatinine, parathyroid hormone (PTH), electrolytes, and body fluid, and hormonal imbalance caused by kidney injury resulting from many diseases in the body[ 3 ]. Uremia is a serious stage of kidney disease, with patients showing clinical manifestations of anorexia, vomiting, nausea, weight loss, fatigue, mental state changes, muscle spasms, and other symptoms[ 4 ], inducing serious harm to the physical and mental health of patients.…”