Risk of Post-polypectomy Bleeding After Colorectal Endoscopic Mucosal Resection in Patients with Chronic Kidney Disease: A Propensity-Matched Analysis of the US Collaborative Network

Background: Studies evaluating the risk of post-polypectomy bleeding (PPB) after colorectal endoscopic mucosal resection (EMR) in patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) are limited. Methods: This retrospective cohort study utilized the U.S. Collaborative Network to assess the risk of PPB after colorectal EMR in patients with CKD compared to controls. Using one-to-one propensity score matching (PSM), the primary outcome measured was PPB within 30 days after colorectal EMR. The PPB risk was further stratified by CKD severity: non-advanced CKD and advanced CKD. Results: After PSM, each cohort included 9,196 patients. Overall, CKD was associated with increased risk of PPB following colorectal EMR (5.4% vs. 3.8%, odds ratio [OR] 1.44, 95% confidence interval [CI] 1.25–1.66, p < 0.001). The PPB risk was significantly higher in patients with advanced CKD (8.1% vs. 4%, OR 2.09, 95% CI 1.65–2.65, p < 0.001), while those with non-advanced CKD showed modest increase in risk of PPB (4.7% vs. 4%, OR 1.20, 95% CI 1.01–1.41, p = 0.03). Conclusion: Patients with CKD had higher risk of PPB than patients without CKD. The PPB risk was notably increased in patients with advanced CKD. Optimizing patients with CKD, especially advanced CKD, before colorectal EMR and monitoring for post-procedure bleeding remains important.