Adverse Events Associated with Routine Colonoscopy in Patients with End-Stage Renal Disease

Background and Aim Although colonoscopy has been widely performed in patients with end-stage renal disease (ESRD), studies on the safety of routine colonoscopy, including bowel preparation and sedation, in these patients are limited. This study aimed to investigate the safety of colonoscopy in patients with ESRD who underwent peritoneal dialysis (PD) or hemodialysis (HD). Methods We retrospectively reviewed 538 patients with ESRD who underwent colonoscopy between 2010 and 2020. We compared the incidence of adverse events (AEs) between the ESRD group and a propensity score-matched control group of healthy adults. Cardiovascular/pulmonary and procedure-related AEs were analyzed. We also compared the rates of AEs between patients who underwent PD or HD. Results The overall rate of AEs was 5.7% in patients with ESRD, which was significantly higher than that in healthy adults (0.6%, P < 0.001). All AEs were cardiovascular/pulmonary in nature, but no perforation or bleeding occurred. Most AEs were not severe and resolved with medical treatment. The incidence of AEs was higher in the HD group than in the PD group, but the difference was not significant (6.1% vs. 3.5%, respectively, P = 0.451). In the HD group, patients with AEs were significantly older than those without AEs (P = 0.009). Conclusions The rate of colonoscopy-related AEs in patients with ESRD on dialysis was higher than that in healthy adults, but most AEs were not severe. Routine colonoscopy may be safely performed in patients with ESRD regardless of the method of dialysis, but more carefully in older patients on HD.