Trends in acute nonvariceal upper gastrointestinal bleeding in dialysis patients

Ju-Yeh Yang, Tsung-Chun Lee, Maria E Montez-Rath, Jane Paik, Glenn M Chertow, Manisha Desai, Wolfgang C Winkelmayer

Research output: Contribution to journalArticlepeer-review

89 Citations (Scopus)

Abstract

Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; P<0.001). In more recent years, patients had higher hematocrit levels before upper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial.

Original languageEnglish
Pages (from-to)495-506
Number of pages12
JournalJournal of the American Society of Nephrology : JASN
Volume23
Issue number3
DOIs
Publication statusPublished - Mar 2012
Externally publishedYes

Keywords

  • Aged
  • Female
  • Gastrointestinal Hemorrhage/epidemiology
  • Humans
  • Incidence
  • Kidney Failure, Chronic/therapy
  • Male
  • Middle Aged
  • Registries
  • Renal Dialysis/adverse effects
  • Risk Factors
  • Survival Rate
  • United States
  • Upper Gastrointestinal Tract

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