Gastrointestinal disease and the kidney.

Renal disease at any stage, from insufficiency to end-stage renal disease requiring dialysis or following renal transplantation, is often accompanied by significant gastrointestinal (GI) symptoms. Conversely, patients with GI disease may present with significant renal complications. Patients with end-stage renal disease, patients undergoing dialysis, and recipients of renal grafts are at increased risk for GI complications, including erosive disease and GI bleeding. Selection of pharmacotherapy for GI conditions in patients with concomitant renal disease is complicated by three factors: (1) the potential for a significant negative impact on renal function, which is already compromised; (2) the requirement for dosing alteration in renal insufficiency; and (3) the potential for drug-drug interactions with concomitant medications. Proton pump inhibitors appear to be the most suitable acid-suppressing therapy for patients with renal disease; recently developed drugs in this class (e.g. rabeprazole) may be the best choice for treatment of patients with both acid-related GI conditions and renal disease.