Natural history of upper and lower gastrointestinal bleeding in hemodialysis patients: A dual-center long-term cohort study.
Aged
Aged, 80 and over
Diverticulum, Colon
/ complications
Female
Follow-Up Studies
Gastrointestinal Hemorrhage
/ epidemiology
Humans
Incidence
Kidney Failure, Chronic
/ therapy
Male
Middle Aged
Renal Dialysis
/ adverse effects
Retrospective Studies
Risk
Risk Factors
Stomach Ulcer
/ complications
Time Factors
Gastrointestinal bleeding
Hemodialysis
Natural history
Journal
Journal of gastroenterology and hepatology
ISSN: 1440-1746
Titre abrégé: J Gastroenterol Hepatol
Pays: Australia
ID NLM: 8607909
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
07
12
2019
revised:
26
04
2020
accepted:
16
05
2020
pubmed:
21
5
2020
medline:
6
7
2021
entrez:
21
5
2020
Statut:
ppublish
Résumé
Knowledge on the risk of gastrointestinal (GI) bleeding in hemodialysis patients is limited. We evaluated the risk of GI bleeding in hemodialysis patients compared with non-hemodialysis patients. We performed a retrospective cohort study from 1996 to 2017 at the Graduate School of Medicine, University of Tokyo, and Horinouchi Hospital. We analyzed patients on hemodialysis for chronic renal failure and controls not on hemodialysis. The primary endpoint was GI bleeding. A survival analysis was performed to estimate the cumulative incidence and hazard ratio of GI bleeding. A total of 14 451 patients were analyzed (417 hemodialysis and 14 034 non-hemodialysis patients). In total, 524 GI bleeding events occurred. Upper and lower GI bleeding occurred in 432 and 92 patients in the hemodialysis and non-hemodialysis groups, respectively. The most frequent source of upper and lower GI bleeding was gastric ulcer and colonic diverticular bleeding, respectively. The cumulative incidence of GI bleeding was 4.44% at 1 year, 7.15% at 3 years, and 10.40% at 5 years in hemodialysis patients; the respective rates were 2.35%, 2.98%, and 3.79% in non-hemodialysis patients during a mean follow-up period of 3.5 years. Hemodialysis was significantly associated with an increased risk of GI bleeding after adjustment (hazard ratio 1.67, P = 0.01, 95% confidence interval 1.13-2.50). Hemodialysis patients had a GI bleeding rate of 10% over 5 years, and hemodialysis was a risk factor for GI bleeding.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
Knowledge on the risk of gastrointestinal (GI) bleeding in hemodialysis patients is limited. We evaluated the risk of GI bleeding in hemodialysis patients compared with non-hemodialysis patients.
METHODS
METHODS
We performed a retrospective cohort study from 1996 to 2017 at the Graduate School of Medicine, University of Tokyo, and Horinouchi Hospital. We analyzed patients on hemodialysis for chronic renal failure and controls not on hemodialysis. The primary endpoint was GI bleeding. A survival analysis was performed to estimate the cumulative incidence and hazard ratio of GI bleeding.
RESULTS
RESULTS
A total of 14 451 patients were analyzed (417 hemodialysis and 14 034 non-hemodialysis patients). In total, 524 GI bleeding events occurred. Upper and lower GI bleeding occurred in 432 and 92 patients in the hemodialysis and non-hemodialysis groups, respectively. The most frequent source of upper and lower GI bleeding was gastric ulcer and colonic diverticular bleeding, respectively. The cumulative incidence of GI bleeding was 4.44% at 1 year, 7.15% at 3 years, and 10.40% at 5 years in hemodialysis patients; the respective rates were 2.35%, 2.98%, and 3.79% in non-hemodialysis patients during a mean follow-up period of 3.5 years. Hemodialysis was significantly associated with an increased risk of GI bleeding after adjustment (hazard ratio 1.67, P = 0.01, 95% confidence interval 1.13-2.50).
CONCLUSIONS
CONCLUSIONS
Hemodialysis patients had a GI bleeding rate of 10% over 5 years, and hemodialysis was a risk factor for GI bleeding.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
112-117Subventions
Organisme : KAKENHI Grants-in-Aid for Scientific Research
ID : 18K07933
Informations de copyright
© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.
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