Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

Abstract

Background Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients. Methods We studied all dialysis patients (1992–2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999. Results Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time. Conclusions In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.

Case report: Sevelamer-associated colitis—a cause of pseudotumor formation with colon perforation and life-threatening bleeding

“…It has been reported that patients on hemodialysis have a high risk of colonic perforation even without sevelamer administration, and there were no significant changes in the incidence of bowel perforation after the approval of sevelamer ( 21 , 22 ).…”

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature

“…A study conducted by Yang JY revealed that the incidence of intestinal perforation in the United States between 1992 and 2005 was approximately 0.4%. The 30-day mortality rates following intestinal perforation were reported to be 42.3% for all cases of intestinal perforation ( 6 ). In our analysis of cases over the past decade involving PD complicated by visceral perforation, we identified 18 reported instances in the literature.…”

Sevelamer-Induced Ischemic Enteritis

“…If sevelamer is not stopped, complications such as ischemia, ulceration, acute anemia, stricture formation, and perforation may occur. [1][2][3][4][5][6]…”