Risk Factors and Characteristics of Gastrointestinal Lesions in Patients with CKD and Anemia Admitted to a Tertiary Hospital: A Single-Center, Retrospective Study

Background: Chronic kidney disease (CKD) frequently presents with anemia as a complication, but the relationship between CKD-associated anemia and gastrointestinal (GI) lesions remains incompletely understood. This study aimed to determine the risk factors and characteristics of GI lesions in CKD patients with anemia. Methods: A retrospective study was conducted and included 568 admitted adult patients with CKD stage IIIa or higher and anemia who underwent endoscopy and/or colonoscopy between September 2017 and January 2024. Patient demographics, clinical characteristics, and endoscopic findings were analyzed using descriptive statistics and multivariable logistic regression. Results: GI lesions were found in 89.96% of the study population. The most common lesion was gastritis (62.50%). Two multivariable models were done. In the primary model, significant risk factors for GI lesions included chronic glomerulonephritis (OR 41.29, CI: 7.95-214.47), hypertensive nephropathy (OR 22.75, CI: 4.53-114.37), and iron supplementation (OR 51.40, CI: 8.04-328.64). A sensitivity analysis done confirmed these associations. Both models consistently identified protective associations with lower hemoglobin levels (OR 0.04-0.08) and obesity (OR 0.05- 0.11). Conclusion: This study shows that GI lesions are much more common in CKD patients with anemia than was previously reported. These findings support the implementation of systematic GI screening protocols for CKD patients, particularly those with identified risk factors, and highlight the need for carefully tailored therapeutic approaches in managing anemia in this population.Model 1 contained all variables of interest with backward elimination, and Model 2 included only those variables that had at least 10 cases in both the GI lesion and without GI lesion groups.