Abstract
BackgroundImpaired kidney function is an established predictor of mortality after acute nonvariceal upper gastrointestinal bleeding (ANVUGIB); however, which factors are associated with mortality after ANVUGIB among patients undergoing dialysis is unknown. We examined the associations among demographic characteristics, dialysis-specific features, and comorbid conditions with short-term mortality after ANVUGIB among patients on dialysis.MethodsDesign: Retrospective cohort study. Setting: United States Renal Data System (USRDS), a nation-wide registry of patients with end-stage renal disease. Participants: All ANVUGIB episodes identified by validated algorithms in Medicare-covered patients between 2003 and 2007. Measurements: Demographic characteristics and comorbid conditions from 1 year of billing claims prior to each bleeding event. We used logistic regression extended with generalized estimating equations methods to model the associations among risk factors and 30-day mortality following ANVUGIB events.ResultsFrom 2003 to 2007, we identified 40,016 eligible patients with 50,497 episodes of ANVUGIB. Overall 30-day mortality was 10.7% (95% CI: 10.4-11.0). Older age, white race, longer dialysis vintage, peritoneal dialysis (vs. hemodialysis), and hospitalized (vs. outpatient) episodes were independently associated with a higher risk of 30-day mortality. Most but not all comorbid conditions were associated with death after ANVUGIB. The joint ability of all factors captured to discriminate mortality was modest (c=0.68).ConclusionsWe identified a profile of risk factors for 30-day mortality after ANVUGIB among patients on dialysis that was distinct from what had been reported in non-dialysis populations. Specifically, peritoneal dialysis and more years since initiation of dialysis were independently associated with short-term death after ANVUGIB.
Highlights
Impaired kidney function is an established predictor of mortality after acute nonvariceal upper gastrointestinal bleeding (ANVUGIB); which factors are associated with mortality after ANVUGIB among patients undergoing dialysis is unknown
While we expected several established risk factors for mortality on dialysis to be associated with short-term mortality after ANVUGIB, we focused on identifying risk factors that are of particular pertinence to the bleeding event, such as history of earlier ANVUGIB episodes, whether the bleeding was peptic ulcer-related, as well as the care setting of its diagnosis and the most recent dialysis modality before the event
We showed that advanced age, hospitalized episodes, and most co-morbidities were independently associated with 30-day mortality after ANVUGIB among patients on dialysis, similar to findings from the general population, while bleeding from peptic ulcer disease rather than from any other cause did not significantly associate with short-term mortality after ANVUGIB
Summary
Impaired kidney function is an established predictor of mortality after acute nonvariceal upper gastrointestinal bleeding (ANVUGIB); which factors are associated with mortality after ANVUGIB among patients undergoing dialysis is unknown. We examined the associations among demographic characteristics, dialysis-specific features, and comorbid conditions with short-term mortality after ANVUGIB among patients on dialysis. Acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) is common among patients on dialysis and associated with poor outcomes. Determinants of mortality following ANVUGIB in the general population included age, certain comorbidities (including cardiovascular disease, liver disease, kidney function, and malignancy), specific endoscopic findings, and biometric and laboratory data at presentation (such as blood pressure and hemoglobin concentrations) [4,5,6,7]. We hypothesized that risk factors might be modified by age, sex, race, and dialysis modality
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