{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:30:07Z","timestamp":1762867807987,"version":"3.40.5"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JASN"],"published-print":{"date-parts":[[2019,6]]},"abstract":"\n Significance Statement<\/jats:title>\n Colorectal cancer screening using fecal immunochemical testing (FIT) is recommended for patients with CKD, whose risk of developing and dying from this malignancy is at least 1.5 times higher than that of the sex- and age-matched general population. However, FIT accuracy in this setting is unknown and is likely to be affected by occult gastrointestinal bleeding from dysfunctional platelets and increased bleeding sensitivity to aspirin. In a large, multinational study, the authors found that FIT appears to be an accurate screening test for patients with CKD, but the risk of major complications from work-up colonoscopies (1.5%) is high compared with this risk in the general population. These findings provide useful estimates of harms and test accuracies to inform colorectal cancer screening decisions across the full spectrum of CKD.<\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u201374 years with CKD (stages 3\u20135 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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\u20135 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.2018121232","type":"journal-article","created":{"date-parts":[[2019,4,30]],"date-time":"2019-04-30T21:36:04Z","timestamp":1556660164000},"page":"1061-1072","source":"Crossref","is-referenced-by-count":24,"title":["One-Time Fecal Immunochemical Screening for Advanced Colorectal Neoplasia in Patients with CKD (DETECT Study)"],"prefix":"10.1681","volume":"30","author":[{"given":"Germaine","family":"Wong","sequence":"first","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Transplant and Renal Research, and"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Richard L.","family":"Hope","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia;"}]},{"given":"Kirsten","family":"Howard","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"}]},{"given":"Jeremy R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Centre for Transplant and Renal Research, and"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8431-2033","authenticated-orcid":false,"given":"Antoni","family":"Castells","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain;"},{"name":"August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain; and"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Hep\u00e1ticas y Digestivas, Spain"}]},{"given":"Simon D.","family":"Roger","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Gosford Hospital, Gosford, Australia;"}]},{"given":"Michael J.","family":"Bourke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Westmead Hospital, Westmead, New South Wales, Australia;"}]},{"given":"Petra","family":"Macaskill","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"}]},{"given":"Robin","family":"Turner","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Biostatistics Unit, Dunedin School of Medicine, University of Otago, Christchurch, New Zealand;"}]},{"given":"Gabrielle","family":"Williams","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Wai Hon","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia;"}]},{"given":"Charmaine E.","family":"Lok","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia;"}]},{"given":"Fritz","family":"Diekmann","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation, Clinical and Provincial Hospital of Barcelona, Barcelona, Spain;"}]},{"given":"Nicholas B.","family":"Cross","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation, Christchurch Hospital, Christchurch, New Zealand;"},{"name":"Department of Medicine, University of Otago, Christchurch, New Zealand;"}]},{"given":"Shaundeep","family":"Sen","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia;"}]},{"given":"Richard D.M.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia;"}]},{"given":"Steven J.","family":"Chadban","sequence":"additional","affiliation":[{"name":"Charles Perkins Centre, The University of Sydney, Sydney, Australia;"},{"name":"Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia;"}]},{"given":"Carol A.","family":"Pollock","sequence":"additional","affiliation":[{"name":"Department of Medicine, Northern Clinical School, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia;"}]},{"given":"Allison","family":"Tong","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Armando","family":"Teixeira-Pinto","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Jean Y.H.","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Mathematics and Statistics, and"}]},{"given":"Narelle","family":"Williams","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6089-5913","authenticated-orcid":false,"given":"Eric Hoi Kit","family":"Au","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Anh","family":"Kieu","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Laura","family":"James","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health, Faculty of Medicine and Health,"},{"name":"Centre for Kidney Research, The Children\u2019s Hospital at Westmead, Westmead, Australia;"}]},{"given":"Jonathan C.","family":"Craig","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health, Flinders University, Adelaide, Australia;"}]}],"member":"276","published-online":{"date-parts":[[2019,4,30]]},"reference":[{"key":"B1-20230929","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1681\/ASN.2008090998","article-title":"Association of CKD and cancer risk in older people.","volume":"20","author":"Wong","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B2-20230929","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1001\/jama.296.23.2823","article-title":"Cancer incidence before and after kidney 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