Evidence‐based Review of Gastrointestinal Bleeding in the Chronic Kidney Disease Patient

Abstract

Patients with end-stage renal disease are more likely to suffer from gastrointestinal (GI) problems, including bleeding from upper and lower sources. Peptic ulcer disease is the most common cause of upper GI bleeding, and although there is some debate in the literature regarding whether the frequency of ulcer disease is higher in patients with kidney disease, it is well established that outcomes are worse in patients with compromised renal function. Angioectasias can be found throughout the GI tract and are another common cause of bleeding; management can be divided into localized endoscopic therapy and systemic hormonal treatment, or surgery for refractory cases. The most frequent causes of lower GI bleeding in this population, in addition to angioectasias, are diverticulosis, hemorrhoids, and ischemic colitis.

Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

“…[8] The exposure to medications that affects the clotting cascade like anticoagulants, antiplatelets and non-steroidal anti-inflammatory agents (NSAIDS) also place ESRD population at increased risk of UGIB. [4,9] Past studies have demonstrated that in ESRD patients, bleeding from the upper GI tract is more common than from the lower GI tract. [10] Also, gastroduodenal ulcers and erosions are among the frequent causative factors for UGIB in hemodialysis patients.…”

“…[1] Multiple factors have been proposed that increase the risk of UGIB in ESRD patients including platelet dysfunction due to uremia, high prevalence of arteriovenous malformations (AVM), various co-morbidities like cardiovascular disease, diabetes mellitus, liver cirrhosis and old age. [4,[7][8] Anemia has also been suggested to increase the risk of bleeding as red blood cells assist in interface of platelets at the site of injury. The improvement of bleeding time in uremic patients with erythropoietin and blood transfusions also favors this theory.…”

“…Most common reason for endoscopic evaluation has been UGIB. [2,4] Several scoring systems have also been Unauthenticated Download Date | 5/12/18 4:58 PM developed to classify patients with UGIB according to their outcome. One such scoring system is the Glasgow Blatchford bleeding Score (GBS), a well-established tool to stratify patients in dire need of intervention from UGIB on the basis of their history, physical examinations and laboratory findings.…”

Risk factors for severity and recurrence of colonic diverticular bleeding

“…This is in accordance with the studies of Aytac et al (26) and Nishikawa et al (23), where renal insufficiency was associated with diverticular rebleeding. Kalman and Pedrosa (38), in their review of gastrointestinal bleeding in CKD patients, stated that this population has an increased risk of gastrointestinal bleeding and that its pathophysiology is often multifactorial. Even though there are no reports in the medical literature specifically linking gastrointestinal bleeding with uremic platelet dysfunction, this is thought to be the major factor that places chronic kidney patients at a higher risk of bleeding.…”

Risk scoring systems to predict in-hospital mortality in patients with acute variceal bleeding due to HCV-induced liver cirrhosis

“…41 In patients with chronic kidney disease, GI bleeding is also a common complication. 42 Anand et al 43 showed that elevated serum creatinine levels are associated with increased rates of mortality and re-bleeding. We check the performance of 8 prognostic scoring systems in cirrhotic patients with AVB.…”