Gastrointestinal disorders and renal failure: Exploring the connection

Nature Reviews Nephrology

Volumn 6, Issue 8, 2010, Pages 480-492

  Shirazian, Shayan ^a   Radhakrishnan, Jai ^a  

^a NewYork Presbyterian Hospital   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMOXICILLIN; CLARITHROMYCIN; METRONIDAZOLE; PROTON PUMP INHIBITOR;

ANGIODYSPLASIA; ANXIETY; CHRONIC KIDNEY DISEASE; COLITIS; COLONOSCOPY; CONSTIPATION; DEPRESSION; DISEASE ASSOCIATION; DIVERTICULOSIS; GASTROINTESTINAL HEMORRHAGE; GASTROINTESTINAL SYMPTOM; HELICOBACTER INFECTION; HELICOBACTER PYLORI; HUMAN; KIDNEY DYSFUNCTION; KIDNEY FAILURE; LASER COAGULATION; MESENTERY DISEASE; PANCREATITIS; PERITONEAL DIALYSIS; PERITONITIS; PRIORITY JOURNAL; REVIEW; STOMACH BYPASS; STOMACH PARESIS; UREMIA; COMPLICATION; DISEASE COURSE; GASTROINTESTINAL DISEASES; INCIDENCE; KIDNEY FAILURE, CHRONIC; PREVALENCE; RISK FACTOR;

DISEASE PROGRESSION; GASTROINTESTINAL DISEASES; HUMANS; INCIDENCE; KIDNEY FAILURE, CHRONIC; PREVALENCE; RISK FACTORS;

EID: 77955087903     PISSN: 17595061     EISSN: 1759507X     Source Type: Journal    
DOI: 10.1038/nrneph.2010.84     Document Type: Review

References (117)

1. Coresh, J. et al. Prevalence of chronic kidney disease in the United States. JAMA 298, 2038-2047 (2007). (Pubitemid 350074801)
2. Xue, J. L., Ma, J. Z., Louis, T. A. & Collins, A. J. Forecast of the number of patients with end- stage renal disease in the United States to the year 2010. J. Am. Soc. Nephrol. 12, 2753-2758 (2001).
3. Collins, A. J., Li, S., Gilbertson, D. T., Liu, J., Chen, S. C. & Herzog, C. A. Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int. Suppl. 87, s24-s31 (2003).
4. Nespor, S. L. & Holley, J. L. Patients on hemodialysis rely on nephrologists and dialysis units for maintenance health care. ASAIO J. 38, M279-M281 (1992).
5. Fabrizi, F. et al. Hepatic disorders in kidney disease. Nat. Rev. Nephrol. doi:10.1038/ nrneph.2010.37.
6. Longstreth, G. F. et al. Functional bowel disorders. Gastroenterology 130, 1480-1491 (2006).
7. Mertz, H. Review article: visceral hypersensitivity. Aliment Pharmacol. Ther. 17, 623-633 (2003).
8. Henningsen, P, Zimmermann, T. & Sattel, H. Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom. Med. 65, 528-533 (2003).
9. Broker, L. E. et al. Upper gastrointestinal symptoms, psychosocial co-morbidity and health care seeking in general practice: population based case control study. BMC Fam. Pract. 10, 1-8 (2009).
10. Kang, J. Y. Systematic review: the influence of geography and ethnicity in irritable bowel syndrome. Aliment. Pharmacol. Ther. 21, 663-676 (2005).
11. Cano, A. E. et al. Gastrointestinal symptoms in patients with end-stage renal disease undergoing treatment by hemodialysis or peritoneal dialysis. Am. J. Gastroenterol. 102, 1990-1997 (2007).
12. Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders. Rome Foundation [online], www.romecriteria.org/ (2009).
13. Asfeldt, A. M. et al. Changes in the prevalence of dyspepsia and Helicobacter pylori infection after 17 years: the S0rreisa gastrointestinal disorder study. Eur. J. Epidemiol. 23, 625-633 (2008).
14. El-Serag, H. B. & Talley, N. J. Systemic review: the prevalence and clinical course of functional dyspepsia. Aliment. Pharmacol. Ther. 19, 643-654 (2004).
15. Strid, H. et al. The prevalence of gastrointestinal symptoms in patients with chronic renal failure is increased and associated with impaired psychological general well-being. Nephrol. Dial. Transplant. 17, 1434-1439 (2002).
16. Abu Farsakh, N. A., Roweily, E., Rababaa, M. & Butchoun, R. Evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis. Nephrol. Dial. Transplant. 11, 847-850 (1996).
17. Yasuda, G. et al. Prevalence of constipation in continuous ambulatory peritoneal dialysis patients and comparison with hemodialysis patients. Am. J. Kidney Dis. 39, 1292-1299 (2002).
18. Wu, M. J. et al. Colonic transit time in long-term dialysis patients. Am. J. Kidney Dis. 44, 322-327 (2004).
19. Evenepoel, P, Meijers, B. K., Bammens, B. R. & Verbeke, K. Uremic toxins originating from colonic microbial metabolism. Kidney Int. Suppl. 76, S12-S19 (2009).
20. Hedayati, S. S., Minhajuddin, A. T., Toto, R. D., Morris, D. W. & Rush, A. J. Validation of depression screening scales in patients with CKD. Am. J. Kidney Dis. 54, 433-439 (2009).
21. Cohen, S. D., Patel, S. S., Khetpal, P, Peterson, R. A. & Kimmel, P L. Pain, sleep disturbance, and quality of life in patients with chronic kidney disease. Clin. J. Am. Soc. Nephrol. 2, 919-925 (2007).
22. Watnick, S. Quality of life and depression in CKD: improving hope and health. Am. J. Kidney Dis. 54, 399-402 (2009).
23. Tougas, G., Chen, Y., Hwang, P, Liu, M. M. & Eggleston, A. Prevalence and impact of upper gastrointestinal symptoms in the Canadian population: findings from the DIGEST study. Domestic/International Gastroenterology Surveillance Study. Am. J. Gastroenterol. 94, 2845-2854 (1999).
24. Drossman, D. A. et al. U. S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig. Dis.Sci. 38, 1569-1580 (1993).
25. Kopple, J. D. Effect of nutrition on morbidity and mortality in maintenance dialysis patients. Am. J. Kidney Dis. 24, 1002-1009 (1994).
26. Hakim, R. M. & Levin, N. Malnutrition in hemodialysis patients. Am. J. Kidney Dis. 21, 125-137 (1993).
27. Koch, C. A. & Uwaifo, G. I. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control? Eur. J. Gastroenterol. Hepatol. 20, 822-825 (2008).
28. Middleton, R. J. et al. The unrecognized prevalence of chronic kidney disease in diabetes. Nephrol. Dial. Transplant. 21, 88-92 (2006).
29. Van Vlem, B. et al. Delayed gastric emptying in dyspeptic chronic hemodialysis patients. Am. J. Kidney Dis. 36, 962-968 (2000).
30. Bytzer, P et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch. Intern. Med. 161, 1989-1996 (2001).
31. Freeman, J. G., Cobden, I., Heaton, A. & Keir, M. Gastric emptying in chronic renal failure. Br. Med. J. (Clin. Res. Ed.) 291, 1048 (1985).
32. McNamee, P T., Moore, G. W., McGeown, M. G., Doherty, C. C. & Collins, B. J. Gastric emptying in chronic renal failure. Br. Med. J. (Clin. Res. Ed.) 291, 310-311 (1985).
33. Soffer, E. E., Geva, B., Helman, C., Avni, Y. & Bar-Meir, S. Gastric emptying in chronic renal failure patients on hemodialysis. J. Clin. Gastroenterol. 9, 651-653 (1987).
34. Brown-Cartwright, D., Smith, H. J. & Feldman, M. Gastric emptying of an indigestible solid in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Gastroenterology 95, 49-51 (1988).
35. Bird, N. J. et al. Gastric emptying in patients with chronic renal failure on continuous ambulatory peritoneal dialysis. Nephrol. Dial. Transplant. 9, 287-290 (1994).
36. Strid, H., Simren, M., Stotzer, P O., Abrahamsson, H. & Bjornsson, E. S. Delay in gastric emptying in patients with chronic renal failure. Scand. J. Gastroenterol. 39, 516-520 (2004).
37. Wysowski, D. K. & Bacsanyi, J. Cisapride and fatal arrhythmia. N. Engl. J. Med. 335, 290-291 (1996).
38. Ross, E. A. & Koo, L. C. Improved nutrition after the detection and treatment of occult gastroparesis in nondiabetic dialysis patients. Am. J. Kidney Dis. 31, 62-66 (1998).
39. Silang, R., Regalado, M., Cheng, T. H. & Wesson, D. E. Prokinetic agents increase plasma albumin in hypoalbuminemic chronic dialysis patients with delayed gastric emptying. Am. J. Kidney Dis. 37, 287-293 (2001).
40. Gallar, P, Oliet, A., Vigil, A., Ortega, O. & Guijo, G. Gastroparesis: an important cause of hospitalization in continuous ambulatory peritoneal dialysis patients and the role of erythromycin. Perit. Dial. Int. 13 (Suppl. 2), S183-S186 (1993).
41. Wadhwa, N. K., Atkins, H. & Cabralda, T. Intraperitoneal erythromycin for gastroparesis. Ann. Intern. Med. 114, 912 (1991).
42. Dishy, V. et al. The effect of sildenafil on gastric emptying in patients with end-stage renal failure and symptoms of gastroparesis. Clin. Pharmacol. Ther. 76, 281-286 (2004).
43. Kang, J. Y., Wu, A. Y., Sutherland, I. H. & Vathsala, A. Prevalence of peptic ulcer in patients undergoing maintenance hemodialysis. Dig. Dis. Sci. 33, 774-778 (1988).
44. Nardone, G. et al. Gastroduodenal lesions and Helicobacter pylori infection in dyspeptic patients with and without chronic renal failure. Helicobacter 10, 53-58 (2005).
45. Khedmat, H. et al. Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients. Transplant. Proc. 39, 1003-1007 (2007).
46. Doherty, C. C. Peptic ulcer and chronic renal failure. Ulster Med. J. 48, 145-154 (1979).
47. Franklin, G., Musola, R. & Mencarelli, R. Morphological changes of the gastroduodenal mucosa in regular dialysis uraemic patients. Histopathology 6, 429-437 (1982).
48. Muto, S., Murayama, N., Asano, Y., Hosoda, S. & Miyata, M. Hypergastrinemia and achlorhydria in chronic renal failure. Nephron 40, 143-148 (1985).
49. Luzza, F. et al. Helicobacter pylori-specific IgG in chronic haemodialysis patients: relationship of hypergastrinaemia to positive serology. Nephrol. Dial. Transplant. 11, 120-124 (1996).
50. Huang, J. J. et al. Diagnostic efficacy of (13) C-urea breath test for Helicobacter pylori infection in hemodialysis patients. Am. J. Kidney Dis. 36, 124-129 (2000).
51. Wang, Y. L., Sheu, B. S., Huang, J. J. & Yang, H. B. Noninvasive stool antigen assay can effectively screen Helicobacter pylori Infection and assess success of eradication therapy in hemodialysis patients. Am. J. Kidney Dis. 38, 98-103 (2001).
52. Talley, N. J. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 129, 1753-1755 (2005).
53. Ramamirtham, P & Savides, T. J. In Complications of Dialysis 1st edn (ed. Lamiere, N.) 605-606 (Marcel Dekker Inc., New York, 2000).
54. Akmal, M., Sawelson, S., Karubian, F. & Gadallah, M. The prevalence and significance of occult blood loss in patients with predialysis advanced chronic renal failure (CRF), or receiving dialytic therapy. Clin. Nephrol. 42, 198-202 (1994).
55. Bini, E. J., Kinkhabwala, A. & Goldfarb, D. S. Predictive value of a positive fecal occult blood test increases as the severity of CKD worsens. Am. J. Kidney Dis. 48, 580-586 (2006).
56. Zuckerman, G. R., Cornette, G. L., Clouse, R. E. & Harter, H. R. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann. Intern. Med. 102, 588-592 (1985).
57. Chalasani, N., Cotsonis, G. & Wilcox, C. M. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am. J. Gastroenterol. 91, 2329-2332 (1996).
58. Poralla, T. Angiodysplasia in the renal patient: how to diagnose and how to treat? Nephrol. Dial. Transplant. 13, 2188-2191 (1998).
59. Karagiannis, S. et al. Wireless capsule endoscopy in the investigation of patients with chronic renal failure and obscure gastrointestinal bleeding (preliminary data). World J. Gastroenterol. 12, 5182-5185 (2006).
60. Alvarez, L., Puleo, J. & Balint, J. A. Investigation of gastrointestinal bleeding in patients with end stage renal disease. Am. J. Gastroenterol. 88, 30-33 (1993).
61. Gupta, N., Longo, W. E. & Vernava, A. M. III. Angiodysplasia of the lower gastrointestinal tract: an entity readily diagnosed by colonoscopy and primarily managed nonoperatively. Dis. Colon Rectum 38, 979-982 (1995).
62. Tomori, K. et al. Gastric angiodysplasia in patients undergoing maintenance dialysis. Adv. Perit. Dial. 19, 136-142 (2003).
63. Liu, Y. K., Kosfeld, R. E. & Marcum, S. G. Treatment of uraemic bleeding with conjugated oestrogen. Lancet 2, 887-890 (1984).
64. Bronner, M. H., Pate, M. B., Cunningham, J. T. & Marsh, W. H. Estrogen-progesterone therapy for bleeding gastrointestinal telangiectasias in chronic renal failure. An uncontrolled trial. Ann. Intern. Med. 105, 371-374 (1986).
65. Manzanera, M. J. et al. Digestive haemorrhage due to angiodysplasia in dialysis patients. Treatment with conjugated estrogens. Nefrologia 25, 412-415 (2005).
66. Wasse, H. et al. Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int. 64, 1455-1461 (2003). (Pubitemid 37153813)
67. Tsai, C. J. & Hwang, J. C. Investigation of upper gastrointestinal hemorrhage in chronic renal failure. J. Clin. Gastroenterol. 22, 2-5 (1996).
68. Scheff, R. T., Zuckerman, G., Harter, H., Delmez, J. & Koehler, R. Diverticular disease in patients with chronic renal failure due to polycystic kidney disease. Ann. Intern. Med. 92, 202-204 (1980).
69. Baggenstoss, A. H. The pancreas in uremia; a histopathologic study. Am. J. Pathol. 24, 1003-1017 (1948).
70. Vaziri, N. D., Dure-Smith, B., Miller, R. & Mirahmadi, M. Pancreatic pathology in chronic dialysis patients-an autopsy study of 78 cases. Nephron 46, 347-349 (1987).
71. Shields, W. The pathology of the pancreas in non-diabetic persons. Arch. Intern. Med. 44, 663-666 (1929).
72. Gibb, W. F. Jr & Logan, V. W. Diabetes mellitus; a study of one hundred and forty-seven autopsies. Arch. Intern. Med. 43, 376-383 (1929).
73. Bruno, M. J. et al. Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology. Gut 46, 385-389 (2000).
74. Lankisch, P G., Weber-Dany, B., Maisonneuve, P & Lowenfels, A. B. Frequency and severity of acute pancreatitis in chronic dialysis patients. Nephrol. Dial. Transplant. 23, 1401-1405 (2008).
75. Rutsky, E. A., Robards, M., Van Dyke, J. A. & Rostand, S. G. Acute pancreatitis in patients with end-stage renal disease without transplantation. Arch. Intern. Med. 146, 1741-1745 (1986).
76. Junge, W., Malyusz, M. & Ehrens, H. J. The role of the kidney in the elimination of pancreatic lipase and amylase from blood. J. Clin. Chem. Clin. Biochem. 23, 387-392 (1985).
77. Royse, V. L., Jensen, D. M. & Corwin, H. L. Pancreatic enzymes in chronic renal failure. Arch. Intern. Med. 147, 537-539 (1987).
78. Donnely, S., Mortimer, L. & Prichard, S. Acute pancreatitis in continuous ambulatory peritoneal dialysis (CAPD). Perit. Dial. Int. 8, 187-190 (1988).
79. Gupta, A., Yuan, Z. Y., Balaskas, E. V., Khanna, R. & Oreopoulos, D. G. CAPD and pancreatitis: no connection. Perit. Dial. Int. 12, 309-316 (1992).
80. Schoenicke, G., Grabensee, B. & Plum, J. Dialysis with icodextrin interferes with measurement of serum alpha-amylase activity. Nephrol. Dial. Transplant. 17, 1988-1992 (2002).
81. Cooke, M. & Sande, M. A. Diagnosis and outcome of bowel infarction on an acute medical service. Am. J. Med. 75, 984-992 (1983).
82. Liavag, I. Diagnosis and treatment of acute mesenteric vascular insufficiency. Geriatrics 24, 49-60 (1969).
83. Yu, C. C. et al. Factors associated with mortality from non-occlusive mesenteric ischemia in dialysis patients. Ren. Fail. 31, 802-806 (2009).
84. Bender, J. S., Ratner, L. E., Magnuson, T. H. & Zenilman, M. E. Acute abdomen in the hemodialysis patient population. Surgery 117, 494-497 (1995).
85. Ori, Y. et al. Non-occlusive mesenteric ischemia in chronically dialyzed patients: a disease with multiple risk factors. Nephron Clin. Pract. 101, c87-c93 (2005).
86. Bassilios, N. et al. Mesenteric ischaemia in haemodialysis patients: a case/control study. Nephrol. Dial. Transplant. 18, 911-917 (2003).
87. Flobert, C. et al. Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialysis. Am. J. Gastroenterol. 95, 195-198 (2000).
88. John, A. S., Tuerff, S. D. & Kerstein, M. D. Nonocclusive mesenteric infarction in hemodialysis patients. J. Am. Coll. Surg. 190, 84-88 (2000).
89. Picazo, M., Cuxart, M., Sans, R., Sarda, C. & Exposito, E. Mesenteric ischemia in hemodialysis patients. Nefrologfa 28, 198-202 (2008).
90. Archodovassilis, F. et al. Nonocclusive mesenteric ischemia: a lethal complication in peritoneal dialysis patients. Perit. Dial. Int. 27, 136-141 (2007).
91. Jain, A. K. & Blake, P G. Non-Pseudomonas gram negative peritonitis. Kidney Int. 69, 1107-1109 (2006).
92. Bunke, C. M., Brier, M. E. & Golper, T. A. Outcomes of single organism peritonitis in peritoneal dialysis: gram negatives versus gram positives in the Network 9 Peritonitis Study. Kidney Int. 52, 524-529 (1997).
93. Suh, H., Wadhwa, K., Cabralda, T. & Sorrento, J. Endogenous Peritonitis and Related Outcome in Peritoneal Dialysis Patients. Advances in PD [online], http://www.advancesinpd.com/adv96/ pt3outcome40-96.html (1996).
94. Tranaeus, A., Heimburger, O. & Granqvist, S. Diverticular disease of the colon: a risk factor for peritonitis in continuous peritoneal dialysis. Nephrol. Dial. Transplant. 5, 141-147 (1990).
95. Bargman, J. et al. Updates Clinical Practice Guidelines and Recommendations-Peritoneal Dialysis Adequacy. KDOQITM Guidelines [online], http://www.kidney.org/professionals/KDOQI/ guideline upHD PD VA/index.htm (2006).
96. Augustine, T., Brown, P W., Davies, S. D., Summers, A. M. & Wilkie, M. E. Encapsulating peritoneal sclerosis: clinical significance and implications. Nephron Clin. Pract. 111, c149-c154 (2009).
97. Kawaguchi, Y., Kawanishi, H., Mujais, S., Topley, N. & Oreopoulos, D. G. Encapsulating peritoneal sclerosis: definition, etiology, diagnosis, and treatment. International Society for Peritoneal Dialysis Ad Hoc Committee on Ultrafiltration Management in Peritoneal Dialysis. Perit. Dial. Int. 20, S43-S55 (2000).
98. Lo, W. K. & Kawanishi, H. Encapsulating peritoneal sclerosis-medical and surgical treatment. Perit. Dial. Int. 29 (Suppl. 2), S211-S214 (2009).
99. Wootton, F. T., Rhodes, D. F., Lee, W. M. & Fitts, C. T. Colonic necrosis with Kayexalate- sorbitol enemas after renal transplantation. Ann. Intern. Med. 111, 947-949 (1989).
100. Bischel, M. D., Reese, T. & Engel, J. Spontaneous perforation of the colon in a hemodialysis patient. Am. J. Gastroenterol. 74, 182-184 (1980).
101. Lillemoe, K. D. et al. Intestinal necrosis due to sodium polystyrene (Kayexalate) in sorbitol enemas: clinical and experimental support for the hypothesis. Surgery 101, 266-272 (1987).
102. Rogers, F. B. & Li, S. C. Acute colonic necrosis associated with sodium polystyrene sulfonate (Kayexalate) enemas in a critically ill patient: case report and review of the literature. J. Trauma 51, 395-397 (2001).
103. Rashid, A. & Hamilton, S. R. Necrosis of the gastrointestinal tract in uremic patients as a result of sodium polystyrene sulfonate (Kayexalate) in sorbitol: an underrecognized condition. Am. J. Surg. Pathol. 21, 60-69 (1997).
104. Shephard, K. V. Cleansing enemas after sodium polystyrene sulfonate enemas. Ann. Intern. Med. 112, 711 (1990).
105. Allen, A. et al. Enteric hyperoxaluria and renal failure associated with lymphangiectasia. Nephrol. Dial. Transplant. 12, 802-806 (1997).
106. Gelbart, D. R., Brewer, L. L., Fajardo, L. F. & Weinstein, A. B. Oxalosis and chronic renal failure after intestinal bypass. Arch. Intern. Med. 137, 239-243 (1977).
107. Wharton, R. et al. Acute deterioration of renal function associated with enteric hyperoxaluria. Clin. Nephrol. 34, 116-121 (1990).
108. Gregory, J. G., Starkloff, E. B., Miyai, K. & Schoenberg, H. W. Urologic complications of ileal bypass operation for morbid obesity. J. Urol. 113, 521-524 (1975).
109. Patel, B. N. et al. Prevalence of hyperoxaluria after bariatric surgery. J. Urol. 181, 161-166 (2009).
110. Asplin, J. R. & Coe, F. L. Hyperoxaluria in kidney stone formers treated with modern bariatric surgery. J. Urol. 177, 565-569 (2007).
111. Nelson, W. K., Houghton, S. G., Milliner, D. S., Lieske, J. C. & Sarr, M. G. Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy: potentially serious and unappreciated complications of Roux-en-Y gastric bypass. Surg. Obes. Relat. Dis. 1, 481-485 (2005).
112. Nasr, S. H. et al. Oxalate nephropathy complicating Roux-en-Y gastric bypass: an underrecognized cause of irreversible renal failure. Clin. J. Am. Soc. Nephrol. 3, 1676-1683 (2008).
113. Lien, Y. H. Is bowel preparation before colonoscopy a risky business for the kidney? Nat. Clin. Pract. Nephrol. 4, 606-614 (2008).
114. Markowitz, G. S. et al. Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum. Pathol. 35, 675-684 (2004).
115. Markowitz, G. S., Whelan, J. & D'Agati, V. D. Renal failure following bowel cleansing with a sodium phosphate purgative. Nephrol. Dial. Transplant. 20, 850-851 (2005).
116. Brunelli, S. M. Association between oral sodium phosphate bowel preparations and kidney injury: a systematic review and meta-analysis. Am. J. Kidney Dis. 53, 448-456 (2009).
117. Hammer, J. et al. Chronic gastrointestinal symptoms in hemodialysis patients. Wien Klin. Wochenschr. 110, 287-289 (1998).