Document Detail


Nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients.
MedLine Citation:
PMID:  23410569     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation.
METHODS: Using Taiwan's National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis.
RESULTS: A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients.
CONCLUSIONS: There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.
Authors:
Jiing-Chyuan Luo; Hsin-Bang Leu; Ming-Chih Hou; Kuang-Wei Huang; Han-Chieh Lin; Fa-Yauh Lee; Wan-Leong Chan; Shing-Jong Lin; Jaw-Wen Chen
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of medicine     Volume:  126     ISSN:  1555-7162     ISO Abbreviation:  Am. J. Med.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-04-11     Revised Date:  2013-11-01    
Medline Journal Info:
Nlm Unique ID:  0267200     Medline TA:  Am J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  264.e25-32     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan. jcluo@vghtpe.gov.tw
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Case-Control Studies
Female
Gastrointestinal Hemorrhage / etiology*
Humans
Kaplan-Meier Estimate
Male
Proportional Hazards Models
Renal Dialysis / adverse effects*
Renal Insufficiency, Chronic / complications
Risk Factors
Sex Factors
Comments/Corrections
Comment In:
Gastroenterology. 2013 Oct;145(4):895-7; discussion 897   [PMID:  23973676 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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