Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

Abstract

Background. Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding. Results. Dialysis CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 1148) and control subjects (n = 1148) (12.9% vs. 3.6% and 2.8%; both P < 0:001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P = 0:003). Conclusion. Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.

Lower rates of endoscopy and higher mortality in end‐stage renal disease patients with gastrointestinal bleeding: A propensity matched national study

“…The rise in the global number of patients with ESRD requiring HD over the past decade has now surfaced as a worldwide health problem, causing considerable strain and substantial burden on health‐care resources 22 . To date, there are no large studies that evaluated the hospital course, health‐care outcomes, endoscopic evaluation, and mortality in patients with ESRD on HD when compared with patients with no renal disease (NRD).…”

Angiodysplasia in Renal Disease Patients: Analysis of Risk Factors and Approach to Manage Such Patients

“…According to the most recent United States Renal Data System (USRDS) database, the prevalence of chronic kidney disease (CKD) was 15% and that of end-stage renal diesase (ESRD) was 2160.7 per million among the United States populations. GI bleeding is a major cause of morbidity and mortality in renal disease patients [2].…”

“…Angiodysplasia is known to be associated with various clinical entities, such as chronic renal insufficiency, aortic stenosis (Heyde's syndrome), von Willebrand disease, cirrhosis, and many autoimmune disorders (primary biliary cirrhosis, diabetes, scleroderma) [2,6].…”

“…It is also the most frequent cause of recurrent bleeding in patients with renal failure [1]. The prevalence of angiodysplasia in renal failure patients ranges from 19% to 32% compared to only 5% in individuals with normal renal function [1,2]. Angiodysplasia presents at a younger age in patients than in the general population.…”

“…Angiodysplasia is a vascular malformation with a diameter of less than 1 cm within the mucosal and submucosal layer of the bowel [1]. Multiple hemorrhagic episodes are frequent and mostly occult and intermittent [1,2].…”