Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease

Received 16 September 2008; accepted 10 April 2009. published online 13 July 2009.

Refers to article:

Continuing Medical Education Exam: January 2010
Raquel E. Davila, Jeffrey H. Lee, William Ross, Shou-Jiang Tang, G.S. Raju, George Triadafilopoulos
Gastrointestinal Endoscopy
January 2010 (Vol. 71, Issue 1, Pages 139-139.e6)
Full-Text PDF (5226 KB)

Background

Patients with end-stage renal disease (ESRD) and peptic ulcer disease (PUD) bleeding may be at high risk of bleeding complications.

Objective

To investigate the outcomes of patients with ESRD and PUD bleeding.

Design

ESRD patients with PUD bleeding were evaluated retrospectively.

Setting

Two tertiary, university-affiliated hospitals.

Patients

A total of 150 PUD bleeding patients were evaluated in 3 groups; end-stage renal disease (ESRD) patients on dialysis (ESRD group) (n = 50) were age matched with patients with chronic kidney disease (CKD) not requiring dialysis (CKD group) (n = 50) and those with normal kidney function (normal group) (n = 50).

Main Outcome Measurements

Rebleeding, transfusions, length of hospitalization, mortality.

Results

Multivariate analysis showed significant predictors of rebleeding to be ESRD and high-risk stigmata. The ESRD group had an odds ratio (OR) of 3.8 (95% CI, 1.4-10.5; P = .008) for rebleeding compared with the normal group, and an OR of 3.8 (95% CI, 1.4-10.3; P = .01) compared with the CKD group. The mean number of (± SD) transfusions was higher in the ESRD group (6.3 ± 5.7 units) than in the normal group (3.6 ± 3.9 units; P = .01). The mean length of hospitalization was higher in the ESRD group than in the normal group (34.0 vs 16.6 days; P = .01). A greater level of comorbidity was the only significant predictor of mortality (OR 6.0; 95% CI, 2.9-12.3; P = .001).

Limitation

Retrospective study.

Conclusion

ESRD dialysis patients with PUD bleeding have greater rebleeding than patients not on dialysis. ESRD patients should be managed as a high-risk group.

Edmonton, Alberta, Canada

Abbreviations: CKD, chronic kidney disease, Cr, creatinine, ESRD, end-stage renal disease, OR, odds ratio, PPI, proton pump inhibitor, PUD, peptic ulcer disease, UGIB, upper GI bleeding

Current affiliations: Department of Medicine (J.C., R.N.F.), Division of Gastroenterology (A.Y., J.L., Q.Z.), University of Alberta, Edmonton, Alberta, Canada

Reprint requests: Justin Cheung, MD, FRCPC, Gastroenterology, Zeidler Ledcor Centre, 130 University Campus, Edmonton, Alberta, Canada T6G 2X8.

DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

See CME section; p. 139

PII: S0016-5107(09)01758-1

doi:10.1016/j.gie.2009.04.014

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