Prevalence of H.Pylori in CKD Patients

Helicobacter pylori is a spiral-shaped, gram-negative flagellated bacterium that usually resides in the gastric mucosa \[1\]. It affects approximately 50% of the world's population, even 80% in lower and middle outcome countries \[1\] \[2\]. The prevalence according to a study conducted by Ankouane et al. in Yaoundé (Cameroon) is up to 72.5% in hospital \[3\]. The main route of transmission is person to person transmission and often occurs in the first 5 years of life \[4\]. Helicobacter pylori is the most common human chronic infection, causing gastrointestinal diseases such as gastric malignancies, gastritis, and ulcerative diseases. H. pylori can also be involved in other non-gastrointestinal infections such as diabetes and metabolic syndrome, heart disease, hematologic disorders, cancer, and chronic kidney disease (CKD) as well as chronic renal failure (CRF) \[5\]. The risk factors for infection with H. pylori are low socioeconomic level, promiscuity, family history of H. pylori infection or gastritis, alcohol consumption, smoking \[6\]. The stomach is reported to be associated with conditions affecting other organs. Such as, an association between atrophic gastritis (AG) and coronary artery disease has been described, with AG representing a potential independent risk factor for coronary artery disease \[7\]. The diagnosis of H. pylori is made by noninvasive methods (the rapid urease test, the breath test, serology, stool antigen test) or invasive methods biopsy-based tests (culture and histology) \[8\]. The gold standard is histology, but current methods have been developed, using high-definition endoscopy \[9\]. Chronic kidney disease (CKD) is a growing disease and public health problem worldwide \[10\]. Gastrointestinal (GI) symptoms are common among subjects with CKD, and their intensity vary slightly to very severe, altering the quality of life and potentially hindering the effectiveness of the treatment \[11\] and also affects their nutrition status leading to the development of malnutrition, which is a potent predictor of morbidity and mortality \[12\]. Patients with chronic renal failure (CRF) often have gastrointestinal symptoms caused not only by H. pylori infection, but also by high urea levels, decline of gastrointestinal motility, hypergastrinemia and high ammonia levels \[10-13\]. Moreover, patients with CRF may have higher risks of gastric mucosal damages compared with individuals with normal renal function because of systemic and/or local chronic circulatory failure \[14\]. Epidemiological studies have revealed a link between H. pylori with insulin resistance and metabolic syndrome , which may increase the risk of CKD. However, up to date there is no conclusive evidence regarding the association between H. pylori infection and CKD \[15\]. A previous study reported that individuals infected with H. pylori had a higher risk of subsequent renal dysfunction than those not infected \[12\]. Conversely, the H. pylori infection rate is lower in patients with peptic ulcer disease and concomitant chronic kidney disease (CKD) than in those without CKD \[13\]. However, the relationship between H. pylori infection and/or gastric disorders and CKD has not been elucidated.