Document Detail

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005).
MedLine Citation:
PMID:  22419235     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients.
METHODS: We studied all dialysis patients (1992-2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999.
RESULTS: Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time.
CONCLUSIONS: In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.
Ju-Yeh Yang; Tsung-Chun Lee; Maria E Montez-Rath; Manisha Desai; Wolfgang C Winkelmayer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-03-09
Journal Detail:
Title:  Journal of nephrology     Volume:  26     ISSN:  1724-6059     ISO Abbreviation:  J. Nephrol.     Publication Date:    2013 Mar-Apr
Date Detail:
Created Date:  2013-03-21     Completed Date:  2013-09-13     Revised Date:  2014-08-13    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  281-8     Citation Subset:  IM    
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MeSH Terms
Chelating Agents / adverse effects
Intestinal Perforation / epidemiology*,  mortality
Middle Aged
Polyamines / adverse effects
Renal Dialysis / adverse effects*,  mortality
Risk Assessment
Risk Factors
Time Factors
United States / epidemiology
Grant Support
Reg. No./Substance:
0/Chelating Agents; 0/Polyamines; 182683-00-7/sevelamer

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

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