Germaine Wong1,2,3, Richard L Hope4, Kirsten Howard5, Jeremy R Chapman2, Antoni Castells6,7,8, Simon D Roger9, Michael J Bourke4, Petra Macaskill5, Robin Turner5,10, Gabrielle Williams5,3, Wai Hon Lim11, Charmaine E Lok11, Fritz Diekmann12, Nicholas B Cross13,14, Shaundeep Sen15, Richard D M Allen16, Steven J Chadban16,17, Carol A Pollock18, Allison Tong5,3, Armando Teixeira-Pinto5,3, Jean Y H Yang19, Narelle Williams5,3, Eric Hoi Kit Au5,3, Anh Kieu5,3, Laura James5,3, Jonathan C Craig20. 1. Sydney School of Public Health, Faculty of Medicine and Health, germaine.wong@health.nsw.gov.au. 2. Centre for Transplant and Renal Research, and. 3. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia. 4. Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia. 5. Sydney School of Public Health, Faculty of Medicine and Health. 6. Gastroenterology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain. 7. August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; and. 8. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Spain. 9. Department of Renal Medicine, Gosford Hospital, Gosford, Australia. 10. Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand. 11. Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia. 12. Department of Nephrology and Kidney Transplantation, Clinical and Provincial Hospital of Barcelona, Barcelona, Spain. 13. Department of Nephrology and Kidney Transplantation, Christchurch Hospital, Christchurch, New Zealand. 14. Department of Medicine, University of Otago, Christchurch, New Zealand. 15. Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia. 16. Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 17. Charles Perkins Centre, The University of Sydney, Sydney, Australia. 18. Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia. 19. School of Mathematics and Statistics, and. 20. College of Medicine and Public Health, Flinders University, Adelaide, Australia.
Abstract
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.
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.
Authors: Claire M Vajdic; Stephen P McDonald; Margaret R E McCredie; Marina T van Leeuwen; John H Stewart; Matthew Law; Jeremy R Chapman; Angela C Webster; John M Kaldor; Andrew E Grulich Journal: JAMA Date: 2006-12-20 Impact factor: 56.272
Authors: Germaine Wong; Margaret W Y Li; Kirsten Howard; Danny K Hua; Jeremy R Chapman; Michael Bourke; Robin Turner; Allison Tong; Jonathan C Craig Journal: Nephrol Dial Transplant Date: 2012-11-25 Impact factor: 5.992
Authors: Anoushka Krishnan; Armando Teixeira-Pinto; Wai H Lim; Kirsten Howard; Jeremy R Chapman; Antoni Castells; Simon D Roger; Michael J Bourke; Petra Macaskill; Gabrielle Williams; Charmaine E Lok; Fritz Diekmann; Nicholas Cross; Shaundeep Sen; Richard D M Allen; Steven J Chadban; Carol A Pollock; Robin Turner; Allison Tong; Jean Y H Yang; Narelle Williams; Eric Au; Anh Kieu; Laura James; Anna Francis; Germaine Wong; Jonathan C Craig Journal: Kidney Int Rep Date: 2020-10-03