Long-term peptic ulcer rebleeding risk estimation in patients undergoing haemodialysis: a 10-year nationwide cohort study

Wu, Chun Ying; Wu, Ming Shiang; Kuo, Ken N.; Wang, Chang Bi; Chen, Yi Ju; Lin, Jaw Town

doi:10.1136/gut.2010.224329

Cited by 58 publications

(47 citation statements)

References 22 publications

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“…Previous studies have indicated that patients undergoing dialysis are at particular risk for recurrence of upper GI bleeding. 2,4 Although upper GI bleeding frequently complicates the course of patients already hospitalized, the management of episodes that begin in the ambulatory setting does not necessarily mandate admission. Almost 40% of upper GI bleeding episodes in Medicare patients were managed in the outpatient setting, 14 and 20% of these episodes recurred.…”

Section: Discussionmentioning

confidence: 99%

“…1 Previous studies have indicated that patients requiring dialysis are particularly prone to developing upper gastrointestinal (GI) bleeding, with subsequent poor outcomes. [2][3][4] In the general (non-ESRD) population, the incidence of, and mortality associated with, acute nonvariceal upper GI bleeding has been declining over time. [5][6][7][8][9][10][11] It is unknown, however, whether the ESRD population has experienced similar changes in rates or complications of this bleeding event and its outcomes.…”

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confidence: 99%

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Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Yang

Lee

Montez‐Rath

et al. 2012

Journal of the American Society of Nephrology

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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.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Yang

Lee

Montez‐Rath

et al. 2012

Journal of the American Society of Nephrology

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“…Using the Taiwan National Health Insurance Research Database (NHIRD), Wu et al found that patients with ESRD had a high long-term risk of developing peptic ulcer re-bleeding, especially in those taking ulcerogenic drugs or who also had H. pylori infection, ischemic heart disease, or liver cirrhosis. 11 However, the long-term risk of UGIB mortality in patients with uremia remained unclear. Therefore, this study aimed to investigate the association between mortality and UGIB in patients with uremia in order to realize the true incidence of mortality caused by UGIB and estimate the in-hospital mortality risk of UGIB in patients with uremia.…”

Section: Introductionmentioning

confidence: 99%

In-Hospital Mortality Risk Estimation in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding Undergoing Hemodialysis: A Retrospective Cohort Study

et al. 2013

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Background: Upper gastrointestinal bleeding (UGIB) is a major cause of clinical bleeding among patients with end-stage renal disease (ESRD). This study aimed to investigate the association between mortality and UGIB in patients with uremia. Methods: From 2004 to 2010, a tertiary hospital-based retrospective cohort comprising 322 patients undergoing hemodialysis was investigated. All the patients were diagnosed with UGIB according to the International Classification of Diseases, 9th Revision (ICD-9) that included peptic ulcer bleeding, duodenal ulcer bleeding, and other symptoms. UGIB was required to be one of the first three discharge diagnoses. Rehospitalization within 3 days after discharge was regarded as the same course. Exclusion criteria were age <20 years, previous gastric resection or vagotomy, esophageal and gastric variceal bleeding, or gastric cancer within the first 2 years of the index hospitalization. Results: The all-cause in-hospital mortality rate of patients with UGIB undergoing hemodialysis was high, with the first-month mortality rate of 13.7%, sixth-month mortality rate of 26.7%, and first-year mortality rate of 27.0%. Using Cox regression models, we found that the high mortality rate of the UGIB group was significantly correlated with older age [adjusted hazard ratio (HR) ¼ 1.02, 95% confidence interval (CI) ¼ 1.01-1.04], female sex (adjusted HR ¼ 1.62, 95% CI ¼ 1.05-2.51), infection during hospitalization (adjusted HR ¼ 1.85, 95% CI ¼ 1.13-3.03), single episodic UGIB (adjusted HR ¼ 2.00, 95% CI ¼ 1.08-3.70), abnormal white blood cell (WBC) count (adjusted HR ¼ 1.59, 95% CI ¼ 1.03-2.45), and albumin level 3 g/dL (adjusted HR ¼ 2.67, 95% CI ¼ 1.51-4.72). Conclusion: In conclusion, patients with ESRD who are admitted with primary UGIB have a profoundly increased risk of all-cause in-hospital mortality during the follow-up period.

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“…Patients with ESRD exhibit higher rates of rebleeding (up to 40.6% in study by Cheung et al [32]), as well as increased delayed rebleeding (beyond seven days) (16,33). ESRD has also been associated with increased long-term peptic ulcer rebleeding (34).…”

Section: Other Biasmentioning

confidence: 99%

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

Ouali

Barkun

Martel

et al. 2014

Canadian Journal of Gastroenterology and Hepatology

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BACKGROUND: Peptic ulcer rebleeding (PUR) usually occurs within three days following endoscopic hemostasis. However, recent data have increasingly suggested delayed rebleeding.OBJECTIVE: To better characterize the timing of PUR (Forrest Ia to IIb) following initially successful endoscopic hemostasis.METHODS: An exhaustive literature search (1989 to 2013), with cross-referencing, was performed to identify pertinent randomized controlled trial (RCT) arms. Patients receiving high-dose proton pump inhibitor (PPI) infusion following successful modern-day endoscopic hemostasis were included. A sensitivity analysis included any patients receiving PPI doses >40 mg daily. The main outcome measure was 30-day rebleeding, while weighted mean averages at t = three, seven, 14 and 28 to 30 days are also reported.RESULTS: Of 756 citations, six RCTs were included (561 patients; 58.5% to 89.5% male; 55.3 to 67.5 years of age). Among patients receiving high-dose PPI (five RCTs [393 patients]), 11.5% (95% CI 8.4% to 14.7%) experienced rebleeding, 55.6% (95% CI 41.1% to 70.1%) rebled within three days, 20% (95% CI 8.3% to 31.7%) between four and seven days, 17.8% (95% CI 6.6% to 28.9%) at eight to 14 days, and 6.7% (95% CI 0% to 14%) at 15 to 28 to 30 days. Using the relaxed lower PPI dosing threshold, similar respective rates were 14.4% (95% CI 11.5% to 17.3%) overall, with interval rates of 39.5% (95% CI 28.9% to 50.15%), 34.6% (95% CI 24.2% to 44.9%), 19.7% (95% CI 11% to 28.4%) and 6.2% (95% CI 0.95% to 11.5%). Qualitative review of patient characteristics, limited by small sample size, possible bias and study heterogeneity, suggested increased patient comorbidity and postendoscopic use of lower PPI dosing may predict delayed rebleeding.CONCLUSION: In patients with high-risk PUR undergoing successful endoscopic hemostasis, most rebled within three days, with many experiencing later rebleeding. Additional research is needed to better predict such an outcome.

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Long-term peptic ulcer rebleeding risk estimation in patients undergoing haemodialysis: a 10-year nationwide cohort study

Abstract: ESRD patients had higher long-term risk of peptic ulcer rebleeding, especially in certain populations. The enhanced risk gradually decreased after the first year and stabilised after the fifth year.

Cited by 58 publications

References 22 publications

Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

Trends in Acute Nonvariceal Upper Gastrointestinal Bleeding in Dialysis Patients

In-Hospital Mortality Risk Estimation in Patients with Acute Nonvariceal Upper Gastrointestinal Bleeding Undergoing Hemodialysis: A Retrospective Cohort Study

Timing of Rebleeding in High-Risk Peptic Ulcer Bleeding after Successful Hemostasis: A Systematic Review

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