Long-Term Risk of Upper Gastrointestinal Hemorrhage after Advanced AKI

Wu, Pei‐Chen; Wu, Chih‐Jen; Lin, Cheng‐Jui; Wu, Vin‐Cent

doi:10.2215/cjn.01240214

Cited by 42 publications

(29 citation statements)

References 41 publications

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“…The NHI database is one of the largest and most comprehensive databases in the world, and has been offering research data in various studies on diagnoses, medication use, and hospitalizations11121314. This study extracted all of the patients with the diagnosis of PA form 23,725,083 beneficiaries in Taiwan.…”

Section: Methodsmentioning

confidence: 99%

Long term outcome of Aldosteronism after target treatments

Wang

Chang

et al. 2016

Sci Rep

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112

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There exists a great knowledge gap in terms of long-term effects of various surgical and pharmacological treatments on outcomes among primary aldosteronism (PA) patients. Using a validated algorithm, we extracted longitudinal data for all PA patients diagnosed in 1997–2010 and treated in the Taiwan National Health Insurance. We identified 3362 PA patients for whom the mean length of follow-up was 5.75 years. PA has higher major cardiovascular events (MACE) than essential hypertension (23.3% vs 19.3%, p = 0.015). Results from the Cox model suggest a strong effect of adrenalectomy on lowering mortality (HR = 0.23 with residual hypertension and 0.21 with resolved hypertension). While need for receptor antagonist (MRA) MRA after diagnosis suggests that a defined daily dose (DDD) of MRA between 12.5 and 50 mg may alleviate risk of death in a U-shape pattern. A specificity test identified patients who has aldosterone producing adenoma (HR = 0.50, p = 0.005) also confirmed adrenalectomy attenuated all-cause mortality. Adrenalectomy decreases long-term all-cause mortality independently from PA cure from hypertension. Prescription corresponding to a DDD between 12.5 and 50 mg may decrease mortality for patients needing MRA. It calls for more attention on early diagnosis, early treatment and prescription of appropriate dosage of MRA for PA patients.

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Section: Methodsmentioning

confidence: 99%

Long term outcome of Aldosteronism after target treatments

Wang

Chang

et al. 2016

Sci Rep

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112

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“…Although alive and dialysis free at 90 days is clearly an important milestone, AKI-D survivors remain at risk for serious complications within the next 1-5 years (6,12,(15)(16)(17)32). The risk of ESRD after AKI-D after early dialysis independence is substantial, ranging from 8% to 21% of survivors (12,39).…”

Section: Long-term Outcomes Of Patients With Aki-d Who Become Dialysimentioning

confidence: 99%

“…57 (49) 59 (51) 11 (10,9) 48 ( (47) 159 (53) 25 (16,8) 134 (45) Cosentino, 1994 (26) (10,13) or have worsening of preexisting CKD (10-13). Therefore, in a single-center study of patients with normal baseline kidney function (serum creatinine 1.3 mg/dl) after 54 months of follow-up, approximately 80% of AKI-D survivors developed CKD stage 3 or higher (10).…”

Section: Long-term Outcomes Of Patients With Aki-d Who Become Dialysimentioning

confidence: 99%

“…Overall in-hospital mortality of patients with AKI-D is 33% (7) and between 50% and 60% in the intensive care unit (ICU) (8,9). Survivors of AKI-D are at risk for long-term complications, including CKD (10-13), ESRD (2,14), bone fractures (15), upper gastrointestinal bleeding (16), stroke (17), and cardiovascular events, including MI and congestive heart failure (6,12). Because observational studies suggest that adverse outcomes are mitigated when the severity and duration of AKI is reduced (18,19), it is hypothesized that targeted measures to facilitate kidney function recovery might improve both kidney-and nonkidneyrelated outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Promoting Kidney Function Recovery in Patients with AKI Requiring RRT

Cerdá

Liu

Cruz

et al. 2015

Clinical Journal of the American Society of Nephrology

111

126

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AKI requiring RRT is associated with high mortality, morbidity, and long-term consequences, including CKD and ESRD. Many patients never recover kidney function; in others, kidney function improves over a period of many weeks or months. Methodologic constraints of the available literature limit our understanding of the recovery process and hamper adequate intervention. Current management strategies have focused on acute care and shortterm mortality, but new data indicate that long-term consequences of AKI requiring RRT are substantial. Promotion of kidney function recovery is a neglected focus of research and intervention. This lack of emphasis on recovery is illustrated by the relative paucity of research in this area and by the lack of demonstrated effective management strategies. In this article the epidemiologic implications of kidney recovery after AKI requiring RRT are discussed, the available literature and its methodologic constraints are reviewed, and strategies to improve the understanding of factors that affect kidney function recovery are proposed. Measures to promote kidney function recovery are a serious unmet need, with a great potential to improve short-and long-term patient outcomes.

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“…A recent meta-analysis showed that ESRD increased the mortality, need for transfusion, rebleeding rate, and length of hospitalization in gastrointestinal (GI) bleeding patients [9]. Several cohort studies also documented that patients with CKD had higher incidences of upper GI bleeding [10,11], peptic ulcer bleeding [12][13][14], and recurrent upper GI rebleeding [15][16][17] than those without CKD [18]. However, few studies investigate the exact incidence of lower GI bleeding and angiodysplasia bleeding in patients with CKD with or without hemodialysis.…”

Section: Introductionmentioning

confidence: 99%

Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

Tsai

Chen

Huang

et al. 2020

Gastroenterology Research and Practice

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Background. Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding. Results. Dialysis CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 1148) and control subjects (n = 1148) (12.9% vs. 3.6% and 2.8%; both P < 0:001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P = 0:003). Conclusion. Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.

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Long-Term Risk of Upper Gastrointestinal Hemorrhage after Advanced AKI

Cited by 42 publications

References 41 publications

Long term outcome of Aldosteronism after target treatments

Long term outcome of Aldosteronism after target treatments

Promoting Kidney Function Recovery in Patients with AKI Requiring RRT

Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

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