Chronic Kidney Disease and End-Stage Renal Disease Predict Higher Risk of Mortality in Patients with Primary Upper Gastrointestinal Bleeding

Abstract

Background: The outcome of gastrointestinal bleeding in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients is difficult to discern from the literature. Many publications are small, single-center series or are from an era prior to advanced interventional endoscopy, widespread use of proton pump inhibitors or treatment for Helicobacter pylori infections. In this study, we quantify the role of CKD and ESRD as independent predictors of mortality in patients admitted to the hospital with a principal diagnosis of primary upper gastrointestinal bleeding (UGIB). Methods: We used the Nationwide Inpatient Sample that contains data on approximately 8 million admissions in 1,000 hospitals chosen to approximate a 20% stratified sample of all US facilities. Patients discharged with the principal diagnosis of primary UGIB, CKD or ESRD were identified through the ninth revision of the International Classification of Diseases, clinical modification (ICD-9-CM) codes. The outcome variables included frequency and in-hospital mortality of UGIB in CKD and ESRD patients as compared to non-CKD patients and were analyzed using logistic regression modeling. Results: In 2007, out of a total of 398,213 admissions with a diagnosis of primary UGIB, 35,985 were in CKD, 14,983 in ESRD, and 347,245 in non-renal disease groups. The OR for primary UGIB hospitalization in CKD and ESRD was 1.30 (95% CI 1.17–1.46) and 1.84 (95% CI 1.61–2.09), respectively. The corresponding all-cause mortality OR was 1.47 (95% CI 1.21–1.78) and 3.02 (95% CI 2.23–4.1), respectively. Conclusion: Patients with CKD or ESRD admitted with primary UGIB have up to three times higher risk of all-cause in-hospital mortality, warranting heightened vigilance by their clinicians.

Upper Gastrointestinal Bleeding in Patients with CKD

“…The association between lower serum albumin values and higher UGIB risk is also supported by a previous study in patients with CKD receiving dialysis (19). A history of UGIB is an important risk factor but has not been taken into consideration in previous studies (1)(2)(3)6,(20)(21)(22). Our study showed that patients with CKD and a history of UGIB had a 2-fold higher risk of UGIB.…”

“…In patients with CKD, UGIB-related hospitalization is associated with a 3-fold increase in in-hospital mortality (2). Risk factors of UGIB include diabetes mellitus, coronary artery disease (CAD) (3), cirrhosis (4,5), use of nonsteroidal anti-inflammatory drugs (NSAIDs) (5), and history of UGIB in patients with CKD (6).…”

Nontraumatic Subarachnoid Hemorrhage in Maintenance Dialysis Hospitalizations

“…Higher risk of gastrointestinal bleeding and subdural hematomas in this population have been described previously. 21,22 Defects in coagulation pathway and use of anticoagulation in dialysis are thought to contribute toward this increased risk of bleeding in patients on maintenance dialysis. We found the incidence of SAH hospitalizations to be higher in females and blacks irrespective of need for maintenance dialysis.…”

Impact of restarting warfarin therapy in renal disease anticoagulated patients with gastrointestinal hemorrhage

“…This conferred with the findings from a large observational study. 7 Uremia was long thought as one of the most important reasons for bleeding in renal disease patients. 21,22 However, even with adjustment of uremia in our study population ESRD continued to have a higher degree of recurrent GIB.…”

“…6 Similarly, patients with chronic kidney disease and ESRD are at higher risk of developing upper gastrointestinal bleeding that increases the mortality by 3 folds in these patients. 7 Atrial fibrillation patients who are anticoagulated are also at 3 folds higher risk of gastrointestinal bleeding. 8 There is currently no data available about the chronic kidney disease or ESRD patients who develop gastrointestinal hemorrhage and interrupt anticoagulation.…”