CRC screening: FIT test effective for patients with CKD

  • Wong G & al.
  • J Am Soc Nephrol
  • 30 avr. 2019

  • Par Jim Kling
  • Résumés d'articles
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Takeaway

  • A 1-time fecal immunochemical test (FIT) may rule out a diagnosis of colorectal cancer for up to 2 years in patients with chronic kidney disease (CKD).

Why this matters

  • Patients with CKD are at an increased risk of colorectal cancer, but also have higher rates of complications with colonoscopy.
  • Performance of FIT in individuals with CKD could be reduced by occult gastrointestinal bleeding from dysfunctional platelets and bleeding resulting from aspirin sensitivity.

Study design

  • Prospective, multicenter study of 1707 subjects with stages III-V CKD, dialysis patients, and renal transplant recipients. Clinical follow-up at 2 years.
  • Funding: National Health and Medical Research Screening and Test Evaluation Program, Better Evidence and Translation in Program. 

Key results

  • Screening positive rate, 21.6%.
  • Advanced colorectal neoplasia (ACN) detection rate was 6.0% (95% CI, 5.0%-7.2%): 5.6% in CKD (95% CI, 4.2%-7.4%), 7.4% in dialysis (95% CI, 5.1%-10.1%), and 5.6% in kidney transplant (95% CI, 3.9%-8.1%).
  • Sensitivity for ACN, 0.90 (95% CI, 0.84-0.95). Specificity, 0.83 (95% CI, 0.81-0.85). Positive predictive value, 0.30 (95% CI, 0.25-0.35). Negative predictive value, 0.99 (95% CI, 0.98-1.0).
  • Among patients who underwent follow-up colonoscopy, 1.5% had major complications such as bowel perforation and major bleeding.

Limitations

  • Potential selection bias.