Risk factors influencing the outcome of peptic ulcer bleeding in chronic kidney disease after initial endoscopic hemostasis

Abstract

Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45–0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.

Resuming aspirin in patients with non-variceal upper gastrointestinal bleeding: a systematic review and meta-analysis

“…Four observational studies [ 16 , 17 , 21 , 26 ] and the single RCT [ 8 ] addressed our primary aim. Nine observational studies addressed our secondary aim [ 14 , 15 , 18 - 20 , 22 - 25 ].…”

Risk of Recurrent Peptic Ulcer Disease in Patients Receiving Cumulative Defined Daily Dose of Nonsteroidal Anti-Inflammatory Drugs

“…In the present study, we defined H. pylori-associated PUD as the use of any recorded H. pylori eradication therapy medications, such as a combination medication prescription of 7–14 days of any of the following antibiotics in the same medication order such as clarithromycin or metronidazole and amoxicillin or tetracycline, in addition to a PPIs or H2 blockers (H2RAs) [16,17,18]. Summary of H. pylori treatment regimens used in this study were summarized in Table S1.…”

First-Line Helicobacter pylori Eradication in Patients with Chronic Kidney Diseases in Taiwan

“…Patients with CKD often have a higher incidence of peptic ulcer disease (PUD) than the general population, with a substantially increased PUD risk during the 10 years following diagnosis [ 3 , 4 ]. Furthermore, CKD patients have higher peptic ulcer bleeding (PUB) complications, such as recurrent bleeding, infection, and mortality than the general population [ 5 – 8 ].…”