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Long-term peptic ulcer rebleeding risk estimation in patients undergoing haemodialysis: a 10-year nationwide cohort study.
MedLine Citation:
PMID:  21266725     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Objective We aimed to study 1-, 5- and 10-year risks of peptic ulcer rebleeding among end-stage renal disease (ESRD) patients with regular haemodialysis, to identify the high-risk subpopulation, and to estimate the number needed to harm (NNH) to increase a peptic ulcer rebleeding in different periods. Design A nationwide cohort study. Setting Data from the Taiwan National Health Insurance Research Database. Patients Uraemic cohort and matched controls were selected from among hospitalised patients with a primary diagnosis of peptic ulcer bleeding. In total, 6447 uraemic patients and 25 788 age-, gender- and gastroprotective agent use-matched controls were selected. Intervention No. Main outcome measures Cumulative incidences and HRs. Results The cumulative incidences of ESRD patients were significantly higher than the cumulative incidences of matched controls (1&emsp14;year: 18.8% vs 14.2%; 5&emsp14;years: 38.5% vs 31.4%; and 10&emsp14;years: 46.3% vs 39.4%; all p<0.001). The NNH to increase a peptic ulcer rebleeding by ESRD at 1, 5 and 10&emsp14;years were 22, 15 and 15, respectively. On multivariate analysis, ESRD (HR=1.38, p<0.0001) was an independent risk factor for rebleeding. Compared with matched controls, ESRD was associated with higher risk of rebleeding especially in patients using ulcerogenic agents (HR=1.33-1.45), indication to prescribe gastroprotective agents (HR=1.44) and with liver cirrhosis (HR=1.45). Conclusions 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.
Authors:
Chun-Ying Wu; Ming-Shiang Wu; Ken N Kuo; Chang-Bi Wang; Yi-Ju Chen; Jaw-Town Lin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-1-25
Journal Detail:
Title:  Gut     Volume:  -     ISSN:  1468-3288     ISO Abbreviation:  -     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2011-1-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985108R     Medline TA:  Gut     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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