Preparation for gastrointestinal procedures in patients with chronic kidney disease

Adults who have chronic kidney disease requiring peritoneal dialysis or haemodialysis can undergo endoscopic gastrointestinal procedures safely. The patient may need admission to hospital to enable close monitoring and management of their fluid status. Outpatient endoscopies are generally performed on a nonhaemodialysis day. Patients on peritoneal dialysis should have their abdomen empty of dialysate, to avoid extrinsic compression of the hollow organs being examined.

Care should be taken when choosing bowel preparation for colonoscopy in patients with chronic kidney disease. Macrogol 3350 is generally recommended for these patients (see Lavage solutions). Oral preparations containing sodium phosphate should not be used because of the risk of fluid shifts, electrolyte disturbances, worsening kidney failure, and acute phosphate nephropathyMoon, 2013.

For patients receiving peritoneal dialysis who undergo colonoscopy, antibiotic prophylaxis may reduce the risk of peritonitis. If prophylaxis is required, see surgical prophylaxis for colorectal surgery for appropriate regimens.