Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8415
Peer-review started: October 31, 2017
First decision: November 14, 2017
Revised: November 23, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: December 21, 2017
Processing time: 50 Days and 18.7 Hours
Chronic kidney disease is a significant comorbidity, which can worsen the outcomes of gastrointestinal (GI) bleeding.
We wanted to understand the role of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the natural history of GI bleeding.
Our goal was to investigate the influence of CKD and ESRD on the outcomes of GI bleeding, based on all available data published in this topic.
A comprehensive search was carried out in PubMed, Embase and Cochrane Library databases for studies detailing the outcomes of GI bleeding in the context of kidney functions. We used the PRISMA P protocol, registered our project through PROSPERO and assessed the quality of the included articles by using the Newcastle-Ottawa Scale, to ensure that this meta-analysis is done to the highest possible standards. The statistical calculations were performed with Comprehensive Meta-Analysis software, using the random effects model (DerSimonian-Laird method).
In this analysis 51315 patients with CKD and 354720 controls were included (6 articles). We found that the mortality of GI bleeding was significantly worse in CKD and ESRD with an OR of 1.79 and 2.53 respectively. Patients with kidney disease needed significantly more transfusion with a MD of 1.86 and the rebleeding rate was significantly worse in the group with impaired kidney function with an OR of 2.51. Patients with impaired kidney function needed significantly longer hospitalization with a MD of 13.25.
This is the first meta-analysis and systematic review in this topic, which quantifies kidney disease as a negative risk factor in GI bleeding. GI bleeding in patients with chronic renal failure significantly increases the mortality rate, rebleeding rate, length of hospitalization, and require more blood transfusion compared to patients with normal kidney functions. Kidney disease significantly worsens the outlook of patients presenting with GI bleeding. Patients with chronic kidney disease will need to be treated with more caution due to the worse outcomes of GI bleeding. Close monitoring of the fluid balance and kidney functions, careful fluid therapy and prevention of acute kidney injury in these patients may improve the outcomes of GI bleeding.
Although CKD, ESRD, and other comorbidities are major risk factors for unfavorable outcomes in GI bleeding, their roles are not well investigated nor understood and they need further scrutiny. We would better understand the role of CKD in ESRD in GI bleeding from analysis of extensive data from large multicenter and multinational observational studies and registries accurately recording the outcomes and the kidney functions.