Non-Variceal Upper Gastrointestinal Hemorrhage in Chronic Kidney Disease Patients: A Nationwide Analysis

Abstract

Background: Chronic kidney disease (CKD) is a common medical problem in the United States with an estimated prevalence of about 15%. There is evidence in medical literature that patients with chronic kidney disease and end stage renal disease have platelet dysfunction. The aim of our study was to determine if CKD predisposes to non variceal upper gastrointestinal hemorrhage (NVUGIH). We also examined CKD as a potential independent risk factor for poor outcome in patients with G.I. hemorrhage. Method: Using the National Inpatient Sample database from 2007, patients aged 18 or more with discharge diagnosis of chronic kidney disease and upper gastrointestinal hemorrhage were identified through appropriate ICD-9-CM codes. Patients with discharge diagnosis codes of variceal hemorrhage were identified and excluded from the analysis. Multivariate logistic regression was performed using survey commands in STATA to find the outcomes of CKD patients having upper gastrointestinal hemorrhage. The analysis was adjusted for age, sex, race and other relevant co-morbid conditions. Results: There were an estimated 1,799,785 adult discharges with chronic kidney disease and of these 35,985 (2%) were diagnosed with NVUGIH as compared to 1.15% of patients with normal kidney functions. Odds of having a NVUGIH in CKD patients was 1.58 (95%CI 1.43-1.76) times higher than those with normal renal function. Mortality in patients with CKD with NVUGIH was 4.19% as compared to 2.38% in patients with normal kidney function (p <0.001). The length of stay for patients with NVUGIH was 1.7 days longer in patients with CKD as compared to patients with normal kidney functions (p<0.001). Conclusion: In this nationally representative patient population, the frequency of NVUGIH is higher in patients with impaired kidney function as compared to patients with normal kidney function. The mortality was higher in CKD patients with NVUGIH.