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

Abstract

Background and Aim Patients with end‐stage renal disease (ESRD) on hemodialysis are considered to be at higher risk of gastrointestinal bleeding (GIB) as compared with those without renal disease (NRD). We conducted a population‐based study using the National Inpatient Sample (NIS) database to study the outcomes of GIB in ESRD. Methods Patients admitted with GIB (upper and lower) from 2005 to 2013 were extracted from the NIS database using ICD‐9 codes. Patients were divided into NRD and ESRD groups, and a 1:1 propensity matched analysis was performed. Various outcomes were compared in both groups, and subgroup analysis based on the timing of endoscopy was also performed. Results A total of 218 032 patients were included in the study. There was an increase in inpatient admissions among ESRD patients with GIB with significant reduction in mortality (P < 0.001). In‐hospital mortality, length of stay, and total costs were significantly higher in ESRD patients as compared with NRD. ESRD patients were less likely to undergo endoscopic evaluation compared with NRD (P < 0.001). Late endoscopy (> 48 h) was associated with increased need for transfusion and health‐care utilization but without a significant difference in mortality as compared with early endoscopy. On multivariate analysis, endoscopy was associated with significantly lower rate of mortality in ESRD patients with GIB (odds ratio 0.28, P < 0.0001). Conclusion End‐stage renal disease patients with GIB had a significantly higher rate of mortality and a higher health‐care utilization with a lower rate of endoscopic evaluation. Endoscopy was associated with a lower mortality rate on multivariate analysis.

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“…Also, Patients' platelet lowering is an important factor associated with hemorrhage in renal failure that leads to anemia and its complications. Anemia could be related to the accumulation of medications, lowering clearance, and anticoagulation use during treatments [45][46][47], such changes correlated with our results. Meanwhile, renal failure patients usually present with multiple oral complaints, including burning and taste alterations.…”

Prediction of Gastrointestinal Bleeding Hospitalization in Hemodialysis

“…A recent study of >200,000 hospitalized patients showed kidney failure patients had lower endoscopy rates and higher mortality rates than matched patients without kidney failure. 4 Furthermore, this study showed kidney failure patients with a major GIB who had an endoscopy exhibited lower mortality rates than those who did not receive an endoscopy. This supports the potential benefits of endoscopy for diagnostic evaluation and treatment as appropriate.…”

“…The consensus was severe bleeding events represent potentially preventable complications that occur more frequently in people with kidney disease as compared to the general population. [1][2][3][4][5][6] Major bleeding events have a 2% to 6% incidence per year among dialysis patients. [7][8][9] Bleeding events differ by modality, with higher rates seen in hemodialysis (HD) compared to peritoneal dialysis (PD).…”

Improving the outcome of gastrointestinal bleeding in ESRD patients: The need of the hour

“…We read with great interest the recently published article by Garg et al, 1 reporting the outcome of gastrointestinal bleeding (GIB) in patients with end-stage renal disease (ESRD) based on the data of GIB from the National Inpatient Sample (NIS) database. The authors reported a significantly higher mortality rate and higher healthcare utilization with a lower rate of endoscopic evaluation among patients with ESRD than those without renal disease (NRD).…”