A Retrospective Analysis of Risk Factors for Mortality during Hemodialysis at a General Hospital That Treats Comprehensive Diseases

Abstract

Objective We analyzed adverse events retrospectively during a three-year follow-up of patients undergoing hemodialysis at the dialysis center of our general hospital that can treat comprehensive diseases and conducted an exploratory study focusing on the risk factors that determine the prognosis of hemodialysis patients. Methods A total of 132 hemodialysis patients at our dialysis center as of June 2017 were included in the study. Data on event incidence, including death and various clinical indicators, were collected in the electronic medical record for three years until June 2020. Results Between June 2017 and June 2020, 33 of the 132 patients died. The mortality group had a lower body mass index (BMI) and a longer duration of hemodialysis already carried out with more preexisting upper gastrointestinal (GI) bleeding, infections, ischemic heart disease (IHD), and malignancy than the survival group. Furthermore, the mortality group took more warfarin, aspirin, proton pump inhibitors and less H2 blockers than the survival group. Occurrence of upper or lower GI bleeding was similar between the mortality and survival groups. In a univariate analysis for mortality, the odds ratio was significantly higher for a low BMI (<18), long duration of hemodialysis, history of upper GI bleeding, and presence of IHD. Multivariable-adjusted odds ratios for mortality were significantly higher for cases with a history of upper GI bleeding and BMI <18. Conclusion A history of upper GI bleeding and low BMI may be poor prognostic factors of hemodialysis patients. Careful management of upper GI bleeding and a low BMI are required during the initiation of hemodialysis.

Gastrointestinal bleeding among 151 patients undergoing maintenance hemodialysis for end-stage renal failure: A 5-year follow-up study

“…Previous studies and recent meta-analyses indicated that the complication rate of GI bleeding in chronic kidney disease was approximately 2%, and the rate increased concomitantly with therapeutic dialysis. [8][9][10][11][12]23] It is well established that eradication therapy for H. pyloriinfected patients prevents peptic ulcer onset. [25,26] Vascular lesions primarily cause upper GI bleeding in patients with eradicated H pylori infection, whereas upper GI bleeding in patients without a history of H pylori infection is primarily attributed to ulcers and erosions.…”

“…[4][5][6][7] GI bleeding is a severe and potentially life-threatening adverse event. During hemodialysis, GI bleeding often escalates into significant bleeding, [7][8][9][10][11][12] and achieving hemostasis can be challenging. [6,13] In Japan, hemodialysis is routinely administered to patients with end-stage renal failure irrespective of comorbidities, underlying diseases causing renal failure, and age.…”

“…Although the primary causes of upper GI bleeding in Japan were previously peptic ulcers caused by Helicobacter pylori (H pylori) infection and nonsteroidal anti-inflammatory drugs (NSAIDs), [7,16] there has been a recent rise in cases of GI bleeding caused by NSAIDs and antithrombotics in both the upper and lower GI tract. [7,14,[16][17][18][19][20][21][22] Although several studies [8][9][10][11][12] and a recent meta-analysis [23] indicate that the incidence of GI bleeding increases in renal failure and that the increase in GI bleeding is exacerbated by hemodialysis, few recent studies have demonstrated the realworld clinical characteristics of hemodialysis patients in a time dependent-manner. The present study aimed to examine the characteristics of upper and lower GI bleeding in 151 chronic hemodialysis patients at Takagi Hospital, a regional core hospital in Japan, over a 5-year longitudinal observational period.…”

“…[4–7] GI bleeding is a severe and potentially life-threatening adverse event. During hemodialysis, GI bleeding often escalates into significant bleeding, [7–12] and achieving hemostasis can be challenging. [6,13]…”

“…Although several studies [8–12] and a recent meta-analysis [23] indicate that the incidence of GI bleeding increases in renal failure and that the increase in GI bleeding is exacerbated by hemodialysis, few recent studies have demonstrated the real-world clinical characteristics of hemodialysis patients in a time dependent-manner. The present study aimed to examine the characteristics of upper and lower GI bleeding in 151 chronic hemodialysis patients at Takagi Hospital, a regional core hospital in Japan, over a 5-year longitudinal observational period.…”