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. 2015 Apr;28(2):235-43.
doi: 10.1007/s40620-014-0132-6. Epub 2014 Sep 4.

Gastrointestinal bleeding in patients on long-term dialysis

Hariprasad Trivedi  1 , Juliana Yang, Aniko Szabo
Affiliations

Gastrointestinal bleeding in patients on long-term dialysis

Hariprasad Trivedi et al. J Nephrol. 2015 Apr.

Abstract

Background: The epidemiology of gastrointestinal bleeding (GIB) in end-stage renal disease (ESRD) has not been adequately characterized. Using United States Renal Data System data we investigated the epidemiology of GIB in hospitalized patients receiving long-term dialysis.

Methods: Medicare ESRD patients who began dialysis between 1996 and 2005 were followed from 90 days after starting dialysis to death, transplant, loss of Medicare, or December 31, 2006. GIB events were identified using claims data. Predictors of GIB incidence were analyzed using over-dispersed Poisson regression and Cox regression was used to evaluate the effect on survival. Repeat episodes were modeled using a partially conditional Cox regression model.

Results: 406,836 patients were followed for 832,131 person-years, during which 133,967 events were identified. The incidence of GIB was stable through year 2000 but steadily increased thereafter. Chronic gastric ulcer and colonic diverticulosis were the commonest defined causes of upper and lower GIB respectively. Age >49 years, female gender, hypertension as the cause of ESRD, and initiation on hemodialysis was associated with a greater risk of GIB. An episode of GIB conferred a increased hazard of death (hazard ratio 1.9, 95% CI 1.86-1.93). A previous episode of GIB was associated with greater hazard of another episode (hazard ratio 3.93, 95% CI 3.82-4.05).

Conclusions: In ESRD patients incident to long-term dialysis the incidence of hospital-associated GIB is increasing, is associated with a greater hazard of death, and carries a great hazard of repeat episodes.

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Conflict of interest statement

Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
Cumulative incidence of gastrointestinal bleeding, transplantation and death in patients incident to long-term dialysis
Fig. 2
Fig. 2
Cumulative incidence of gastrointestinal bleeding in incident dialysis patients with various characteristics
Fig. 3
Fig. 3
Proportion of patients with gastrointestinal bleed-free survival at various time points (x-axis) after first six episodes of bleeding; e.g. top curve represents the proportion with bleed-free survival after the first episode of bleeding, second curve similar proportion after the second bleed, and so on (shaded areas represent 95 % confidence intervals) In a reference group of white males under 40 years of age, incident to dialysis in 1996–1997 with diabetes mellitus as the cause of end-stage renal disease
See this image and copyright information in PMC

References

    1. Luo J-C, Leu H-B, Huang K-W, Huang C–C, Hou M-C, Lin H-C, Lee F-Y, Lee S-D. Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis. CMAJ. 2011;183:E1345–E1351. - PMC - PubMed
    1. Luo J-C, Leu H-B, Hou M-C, Huang K-W, Lin H-C, Lee F-Y, Chan W-L, Lin S-J, Chen J-W. Nonpeptic ulcer, non-variceal gastrointestinal bleeding in hemodialysis patients. Am J Med. 2013;126:264.e25–264.e32. - PubMed
    1. Toke AB. GI bleeding risk in patients undergoing dialysis. Gastrointest Endosc. 2010;71:50–51. - PubMed
    1. US Renal Data System. USRDS 2013 annual data report. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda: 2013.
    1. Sood P, Kumar G, Nanchal RA, Ahmad S, Ali M, Kumar N, Ross EA. Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol. 2012;35:216–224. - PMC - PubMed

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