<i>Helicobacter Pylori</i> Infection and Gastroduodenal Lesions in Patients with Chronic Kidney Disease: A Comparative Study

Abstract

Introduction: Gastroduodenal lesions are common in chronic kidney disease (CKD). They are linked to various factors including Helicobacter pylori infection ( H. pylori ). Few data are available in Africa on H. pylori infection and chronic kidney disease. The aim of this study was to assess the impact of H. pylori infection and to describe the gastroduodenal lesions found in patients with chronic kidney disease. Patients and Methods: A cross-sectional study was conducted, February 1 st to May 31 st , 2021, at the Douala General Hospital in Cameroon. We included patients with CKD classified as stages 3 to 5 according KDIGO classification, on hemodialysis or not, who agreed to participate in the study. They were matched with a “control” population including patients with normal renal function according to sex and age (ratio 1:2). Patients on antibiotics and/or proton pump inhibitors were excluded. We collected data from CKD patients and from medical records for non-CKD group. Each patient underwent an upper digestive endoscopy and identification of H. pylori using a urease rapid test. Logistic regression was used to identify independent associations for a significance level set at p < 0.05. Results: We included 99 patients including 33 with CKD and 66 control patients. Among patients with CKD, the predominance was male (n = 18/33 or 54.5%). The mean age was 51.2 ± 12.8 years. Arterial hypertension was the first etiology of CKD (n = 13 or 39.4%). The prevalence of H. pylori in patients with CKD was 63.6% versus 37.9% in control patients (p-value = 0.015). The main endoscopic lesions were erosive gastropathy (n = 14 or 42.4%) and erythematous gastropathy (n = 7 or 21.2%). Patients with CKD were 5 times more likely to have H. pylori infection (OR = 5.69; CI 95% 0.14 - 0.82; p = 0.017). Factors associated with H. pylori infection were chronic kidney disease (aOR = 1.02; CI 95% 0.14 - 0.82; p = 0.017) and hemodialysis (aOR = 10; CI 95% 1.08 - 91.9; p = 0.042). Conclusion: The prevalence of H. pylori infection is higher in patients with CKD. Endoscopic lesions are inflammatory. Factors associated with H. pylori infection are chronic kidney disease and hemodialysis.