One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study)

Germaine Wong, Richard L. Hope, Kirsten Howard, Jeremy R. Chapman, Antoni Castells, Simon D. Roger, Michael J. Bourke, Petra Macaskill, Robin Turner, Gabrielle Williams, Wai Hon Lim, Charmaine E. Lok, Fritz Diekmann, Nicholas B. Cross, Shaundeep Sen, Richard D.M. Allen, Steven J. Chadban, Carol A. Pollock, Allison Tong, Armando Teixeira-PintoJean Y.H. Yang, Narelle Williams, Eric Hoi Kit Au, Anh Kieu, Laura James, Jonathan C. Craig

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

BACKGROUND: In patients with CKD, the risk of developing colorectal cancer is high and outcomes are poor. Screening using fecal immunochemical testing (FIT) is effective in reducing mortality from colorectal cancer, but performance characteristics of FIT in CKD are unknown. METHODS: To determine the detection rates and performance characteristics of FIT for advanced colorectal neoplasia (ACN) in patients with CKD, we used FIT to prospectively screen patients aged 35-74 years with CKD (stages 3-5 CKD, dialysis, and renal transplant) from 11 sites in Australia, New Zealand, Canada, and Spain. All participants received clinical follow-up at 2 years. We used a two-step reference standard approach to estimate disease status. RESULTS: Overall, 369 out of 1706 patients who completed FIT (21.6%) tested positive; 323 (87.5%) underwent colonoscopies. A total of 1553 (91.0%) completed follow-up; 82 (4.8%) had died and 71 (4.2%) were lost. The detection rate of ACN using FIT was 6.0% (5.6%, 7.4%, and 5.6% for stages 3-5 CKD, dialysis, and transplant). Sensitivity, specificity, and positive and negative predictive values of FIT for ACN were 0.90, 0.83, 0.30, and 0.99, respectively. Of participants who underwent colonoscopy, five (1.5%) experienced major colonoscopy-related complications, including bowel perforation and major bleeding. CONCLUSIONS: FIT appears to be an accurate screening test for patients with CKD, such that a negative test may rule out the diagnosis of colorectal cancer within 2 years. However, the risk of major complications from work-up colonoscopy are at least ten-fold higher than in the general population.

Original languageEnglish
Pages (from-to)1061-1072
Number of pages12
JournalAmerican Society of Nephrology
Volume30
Issue number6
DOIs
Publication statusPublished - Jun 2019

Keywords

  • cancer
  • chronic kidney disease
  • screening
  • test performance

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    Wong, G., Hope, R. L., Howard, K., Chapman, J. R., Castells, A., Roger, S. D., Bourke, M. J., Macaskill, P., Turner, R., Williams, G., Lim, W. H., Lok, C. E., Diekmann, F., Cross, N. B., Sen, S., Allen, R. D. M., Chadban, S. J., Pollock, C. A., Tong, A., ... Craig, J. C. (2019). One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study). American Society of Nephrology, 30(6), 1061-1072. https://doi.org/10.1681/ASN.2018121232