Medical College of Wisconsin
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Gastrointestinal bleeding in patients on long-term dialysis. J Nephrol 2015 Apr;28(2):235-43

Date

09/05/2014

Pubmed ID

25185727

Pubmed Central ID

PMC4986509

DOI

10.1007/s40620-014-0132-6

Scopus ID

2-s2.0-84925935014   11 Citations

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.

Author List

Trivedi H, Yang J, Szabo A

Author

Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Administrative Claims, Healthcare
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Child
Child, Preschool
Diverticulosis, Colonic
Female
Gastrointestinal Hemorrhage
Hospitalization
Humans
Hypertension
Incidence
Infant
Infant, Newborn
Kidney Failure, Chronic
Male
Middle Aged
Recurrence
Renal Dialysis
Sex Factors
Stomach Ulcer
Time Factors
United States
Young Adult
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a