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Gastrointestinal bleeding in patients on long-term dialysis

Journal of Nephrology Aims and scope Submit manuscript

Abstract

Background

The epidemiology of gastrointestinal bleeding (GIB) in end-stage renal disease (ESRD) has not been adequately characterized. Using United States Renal Data System data we investigated the epidemiology of GIB in hospitalized patients receiving long-term dialysis.

Methods

Medicare ESRD patients who began dialysis between 1996 and 2005 were followed from 90 days after starting dialysis to death, transplant, loss of Medicare, or December 31, 2006. GIB events were identified using claims data. Predictors of GIB incidence were analyzed using over-dispersed Poisson regression and Cox regression was used to evaluate the effect on survival. Repeat episodes were modeled using a partially conditional Cox regression model.

Results

406,836 patients were followed for 832,131 person-years, during which 133,967 events were identified. The incidence of GIB was stable through year 2000 but steadily increased thereafter. Chronic gastric ulcer and colonic diverticulosis were the commonest defined causes of upper and lower GIB respectively. Age >49 years, female gender, hypertension as the cause of ESRD, and initiation on hemodialysis was associated with a greater risk of GIB. An episode of GIB conferred a increased hazard of death (hazard ratio 1.9, 95 % CI 1.86–1.93). A previous episode of GIB was associated with greater hazard of another episode (hazard ratio 3.93, 95 % CI 3.82–4.05).

Conclusions

In ESRD patients incident to long-term dialysis the incidence of hospital-associated GIB is increasing, is associated with a greater hazard of death, and carries a great hazard of repeat episodes.

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Acknowledgments

We thank Agnes Libot, MD for help in identifying ICD-9-CM codes of gastrointestinal bleeding and Qun Xiang, MS for help in statistical analysis. Support received by grant 8UL1TR000055 from the Clinical and Translational Science Award (CTSA) program of the National Center for Research Resources and the National Center for Advancing Translational Sciences.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Correspondence to Hariprasad Trivedi.

Additional information

The data reported here have been supplied by the United States Renal Data System (USRDS). The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US government.

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Trivedi, H., Yang, J. & Szabo, A. Gastrointestinal bleeding in patients on long-term dialysis. J Nephrol 28, 235–243 (2015). https://doi.org/10.1007/s40620-014-0132-6

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  • DOI: https://doi.org/10.1007/s40620-014-0132-6

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