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Abstract

Thank you for your comments. Gastrointestinal bleeding (GIB) is not rare in patients with chronic renal failure. The common causes of GIB in these patients include gastroduodenal ulcers, erosive esophagitis/gastritis/duodenitis, and angiodysplasia (angioectasias) bleeding. In Taiwan, only one tenth of about 45,000 chronic renal failure patients underwent regular peritoneal dialysis (PD); others underwent hemodialysis (HD). Using the same database and study design (CMAJ 2011;183:E1345–E1351; Am J Med 2013;126:264.e25–32), we analyzed data from 2239 PD patients, 2328 HD patients, 2267 chronic kidney disease (CKD) patients, and 4574 controls with age and gender matching in a 1:1:1:2 ratio. Cox proportional hazard regression analysis showed that CKD (hazard ratio [HR], 3.99; 95% confidence interval [CI], 2.24–7.13) had similar risk of peptic ulcer bleeding with PD (HR, 3.71; 95% CI, 2.00–6.87). HD was most risky (HR, 11.96; 95% CI, 7.04–20.31). Regarding the issue of nonpeptic ulcer, nonvariceal bleeding, Cox regression analysis also showed that CKD (HR, 3.01; 95% CI, 1.84–6.23) had similar HR of nonpeptic ulcer, nonvariceal bleeding with PD (HR, 3.13; 95% CI, 1.87–6.41). HD also carried a greater risk (HR, 10.26; 95% CI, 6.14–17.55) than CKD and PD. In fact, HD patients are older, have worse self-care ability and performance status, and have more comorbidities than PD patients. Moreover, the use of heparin during HD seems to exaggerate bleeding risk in patients with an existing GI lesion. In facing chronic renal failure patients with risk of GIB, PD rather than HD may be a strategy to decrease GIB. Thank you for your comments. Gastrointestinal bleeding (GIB) is not rare in patients with chronic renal failure. The common causes of GIB in these patients include gastroduodenal ulcers, erosive esophagitis/gastritis/duodenitis, and angiodysplasia (angioectasias) bleeding. In Taiwan, only one tenth of about 45,000 chronic renal failure patients underwent regular peritoneal dialysis (PD); others underwent hemodialysis (HD). Using the same database and study design (CMAJ 2011;183:E1345–E1351; Am J Med 2013;126:264.e25–32), we analyzed data from 2239 PD patients, 2328 HD patients, 2267 chronic kidney disease (CKD) patients, and 4574 controls with age and gender matching in a 1:1:1:2 ratio. Cox proportional hazard regression analysis showed that CKD (hazard ratio [HR], 3.99; 95% confidence interval [CI], 2.24–7.13) had similar risk of peptic ulcer bleeding with PD (HR, 3.71; 95% CI, 2.00–6.87). HD was most risky (HR, 11.96; 95% CI, 7.04–20.31). Regarding the issue of nonpeptic ulcer, nonvariceal bleeding, Cox regression analysis also showed that CKD (HR, 3.01; 95% CI, 1.84–6.23) had similar HR of nonpeptic ulcer, nonvariceal bleeding with PD (HR, 3.13; 95% CI, 1.87–6.41). HD also carried a greater risk (HR, 10.26; 95% CI, 6.14–17.55) than CKD and PD. In fact, HD patients are older, have worse self-care ability and performance status, and have more comorbidities than PD patients. Moreover, the use of heparin during HD seems to exaggerate bleeding risk in patients with an existing GI lesion. In facing chronic renal failure patients with risk of GIB, PD rather than HD may be a strategy to decrease GIB. Causes of Gastrointestinal Hemorrhage in Patients with Chronic Renal FailureGastroenterologyVol. 145Issue 4PreviewLuo JC, Leu HB, Hou MC, et al. Nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients. Am J Med 2013;126:e25–32. Full-Text PDF