|
1
|
Khan A, Mushtaq M, Movva G, Sohal A, Yang J. Gastrointestinal disease in end-stage renal disease. World J Nephrol 2025; 14:101917. [DOI: 10.5527/wjn.v14.i1.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/24/2024] [Accepted: 01/03/2025] [Indexed: 01/20/2025] Open
Abstract
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy (i.e. renal transplant or dialysis), it is called end-stage renal disease (ESRD). Patients with ESRD often experience a range of gastrointestinal (GI) symptoms, with prevalence rates reported as high as 77%-79%. These symptoms and pathologies arise from various factors, including electrolyte imbalance, fluid imbalance, toxin buildup, uremia, medications, dietary and lifestyle restrictions, and the effects of dialysis. GI diseases in patients with renal failure can be further categorized into upper GI, small bowel, and lower GI issues. Common conditions include gastroesophageal reflux disease, nausea and vomiting, dysmotility within the esophagus and stomach, upper GI bleeding, peptic ulcer bleeding, angioectasia, irritable bowel syndrome, mesenteric ischemia, angiodysplasia, diverticular disease, constipation, pancreatitis, and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis. This review assesses the existing literature on the different GI diseases among individuals with ESRD, shedding light on their pathophysiology and prevalence.
Collapse
Affiliation(s)
- Ayesha Khan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Muhammad Mushtaq
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Giri Movva
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Aalam Sohal
- Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
| |
Collapse
|
|
2
|
Lin Y, Li C, Waters D, Kwok CS. Gastrointestinal bleeding in chronic kidney disease patients: a systematic review and meta-analysis. Ren Fail 2023; 45:2276908. [PMID: 37955109 PMCID: PMC10796123 DOI: 10.1080/0886022x.2023.2276908] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Gastrointestinal bleeding (GIB) is a major cause of mortality in patients with renal failure. We conducted a systematic review of the literature to evaluate the rates, predictors, and outcomes of GIB in patients with chronic kidney disease (CKD). A search of MEDLINE and EMBASE databases was performed, and data were extracted from relevant studies. Statistical pooling was performed to determine the rate of GIB in patients with CKD, and a random-effect meta-analysis was performed to determine the predictors of GIB and mortality in patients with GIB. Twenty-two studies were included in this review, with 7,810,273 patients with CKD included in the analysis. The pooled results of five studies suggested that the rate of GIB in patients with CKD was 2.2%, and among the studies in which patients with CKD underwent endoscopy, the pooled results for GIB were 35.8%. Receipt of dialysis (OR 14.48, 95%CI 4.96-42.32), older age (OR 1.03, 95%CI 1.02-1.05), diabetes mellitus (OR 1.30, 95%CI 1.22-1.39), history of ulcers (OR 1.53, 95%CI 1.03-2.26), and cirrhosis (OR 1.73, 95%CI 1.41-2.12) were significantly associated with GIB. The pooled results suggest a twofold increase in the odds of mortality with GIB, with significant heterogeneity (OR 2.12, 95%CI 1.45-3.10, I2 = 93%). GIB in patients with CKD affects 2% of patients but can be greater in the group of patients who underwent endoscopy. Receipt of dialysis is a strong predictor of GIB, and sustained GIB is associated with a twofold increase in the odds of mortality compared to patients without GIB.
Collapse
Affiliation(s)
- Yanshan Lin
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Chunqun Li
- Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - David Waters
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Chun Shing Kwok
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
- Department of Cardiology, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK
| |
Collapse
|
|
3
|
Su N, Tang X, Wang X, Wen Y, Feng X, Zhou Q, Zhan X, Shang S. Association of Serum Magnesium with Gastrointestinal Bleeding in Peritoneal Dialysis Patients: a Multicentre Retrospective Study. Biol Trace Elem Res 2023; 201:2775-2783. [PMID: 36008701 DOI: 10.1007/s12011-022-03391-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/11/2022] [Indexed: 11/02/2022]
Abstract
Serum magnesium is involved in the process of blood coagulation, and low serum magnesium is associated with haemorrhagic diseases. No studies have explored the relationship between serum magnesium and gastrointestinal bleeding (GIB). This study aimed to explore the association between serum magnesium and GIB in peritoneal dialysis (PD) patients. This was a multicentre retrospective cohort study. The primary endpoint was GIB. According to the baseline serum magnesium level of 0.7 mmol/L, patients were divided into two groups: the hypomagnesaemia group and the nonhypomagnesaemia group. A multivariate Cox regression model was used to investigate the association between hypomagnesaemia and GIB. A total of 654 PD patients from four Chinese peritoneal dialysis centres were recruited from February 1, 2010 to January 31, 2020. During the follow-up, 47 patients experienced GIB. Kaplan-Meier curves showed that there was a significant difference in the risk of GIB between the two groups (log-rank = 11.82, P < 0.001). The multivariable Cox regression model showed that the risk of GIB was higher in the hypomagnesaemia group than the nonhypomagnesaemia group after adjustment for demographic variables and laboratory indicators (HR = 3.007, 95% CI 1.488-6.079, P = 0.002). A baseline lower serum magnesium level was associated with a higher risk of GIB in PD patients.
Collapse
Affiliation(s)
- Ning Su
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuan-cun, Er-heng Road, Tian-He District, Guangzhou 510000, 510655, China
- Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xingming Tang
- Department of Nephrology, DongGuan SongShan Lake Hospital, Dongguan, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Sijia Shang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, 26 Yuan-cun, Er-heng Road, Tian-He District, Guangzhou 510000, 510655, China.
| |
Collapse
|
|
4
|
Garg R, Parikh MP, Chadalvada P, Singh A, Sanaka K, Ahuja KR, Aggarwal M, Veluvolu R, Vignesh S, Rustagi T. Lower rates of endoscopy and higher mortality in end-stage renal disease patients with gastrointestinal bleeding: A propensity matched national study. J Gastroenterol Hepatol 2022; 37:584-591. [PMID: 34989024 DOI: 10.1111/jgh.15771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Patients with end-stage renal disease (ESRD) on hemodialysis are considered to be at higher risk of gastrointestinal bleeding (GIB) as compared with those without renal disease (NRD). We conducted a population-based study using the National Inpatient Sample (NIS) database to study the outcomes of GIB in ESRD. METHODS Patients admitted with GIB (upper and lower) from 2005 to 2013 were extracted from the NIS database using ICD-9 codes. Patients were divided into NRD and ESRD groups, and a 1:1 propensity matched analysis was performed. Various outcomes were compared in both groups, and subgroup analysis based on the timing of endoscopy was also performed. RESULTS A total of 218 032 patients were included in the study. There was an increase in inpatient admissions among ESRD patients with GIB with significant reduction in mortality (P < 0.001). In-hospital mortality, length of stay, and total costs were significantly higher in ESRD patients as compared with NRD. ESRD patients were less likely to undergo endoscopic evaluation compared with NRD (P < 0.001). Late endoscopy (> 48 h) was associated with increased need for transfusion and health-care utilization but without a significant difference in mortality as compared with early endoscopy. On multivariate analysis, endoscopy was associated with significantly lower rate of mortality in ESRD patients with GIB (odds ratio 0.28, P < 0.0001). CONCLUSION End-stage renal disease patients with GIB had a significantly higher rate of mortality and a higher health-care utilization with a lower rate of endoscopic evaluation. Endoscopy was associated with a lower mortality rate on multivariate analysis.
Collapse
Affiliation(s)
- Rajat Garg
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Malav P Parikh
- Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Pravallika Chadalvada
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amandeep Singh
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Krishna Sanaka
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Keerat R Ahuja
- Department of Cardiology, Tower Health, Philadelphia, Pennsylvania, USA
| | - Manik Aggarwal
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rajesh Veluvolu
- Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Shivakumar Vignesh
- Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
| | - Tarun Rustagi
- Department of Gastroenterology, University of New Mexico, Albuquerque, New Mexico, USA
| |
Collapse
|
|
5
|
Hsueh L, Hu SL, Shah AD. Periprocedural Peritonitis Prophylaxis: A Summary of the Microbiology and the Role of Systemic Antimicrobials. KIDNEY DISEASES 2021; 7:90-99. [PMID: 33824867 DOI: 10.1159/000513773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/14/2020] [Indexed: 01/13/2023]
Abstract
Background Peritonitis is a leading complication of peritoneal dialysis (PD). One strategy that the International Society for Peritoneal Dialysis (ISPD) has used to help mitigate the morbidity and mortality associated with peritonitis is through prevention, including antibiotic prophylaxis utilization in high-risk situations. The aim of this study is to summarize our current understanding of postprocedural peritonitis and discuss the existing data behind periprocedural antibiotic prophylaxis, focusing primarily on PD catheter insertion, dental procedures, colonoscopies, upper endoscopies with gastrostomy, and gynecologic procedures. Summary The ISPD currently recommends intravenous antibiotics prior to PD catheter insertion, colonoscopies, and invasive gynecologic procedures, though prophylaxis has only demonstrated benefit in a prospective, randomized control setting for PD catheter insertion. However, multiple retrospective studies exist that support the use of antibiotic prophylaxis for the other 2 procedures. No specific antibiotic regimen has been established as most optimal to prevent peritonitis for any of the 3 procedures. Antibiotic coverage should include the Enterobacteriaceae family, as well as Gram-positive organisms commonly found on the skin flora for PD catheter insertion, anaerobes for colonoscopies, and common organisms from the urogenital flora in gynecologic procedures. Additionally, the ISPD currently recommends oral amoxicillin prior to dental procedures. There is currently no ISPD recommendation to provide antibiotic prophylaxis prior to an upper endoscopy with or without gastrostomy, though this is a potential area for research. Key Messages PD patients are at high risk for developing peritonitis after typical procedures. Antibiotic prophylaxis is a potential strategy that the ISPD utilizes to prevent these infections. However, further research needs to be done to determine the optimal antibiotic regimen.
Collapse
Affiliation(s)
- Leon Hsueh
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Medicine, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Susie L Hu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Ankur D Shah
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Division of Kidney Disease and Hypertension, Rhode Island Hospital, Providence, Rhode Island, USA.,Division of Nephrology, Medicine Service, Providence Veterans Affairs Medical Center, Providence, Rhode Island, USA
| |
Collapse
|
|
6
|
Garlapati P, Gajjar B, Then EO, Gayam V. End-stage renal disease and lower gastrointestinal bleeding-A propensity-matched analysis of nationwide inpatient sample. Int J Clin Pract 2021; 75:e13633. [PMID: 32741101 DOI: 10.1111/ijcp.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022] Open
Abstract
AIMS We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay and resource utilisation in end-stage renal disease (ESRD) patients. MATERIAL AND METHODS The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS) and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients. RESULTS We identified 2 187 954 ESRD patients, of whom 242 075 has LGIB, and 1 945 879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P = .00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P = .00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P = .002). Advanced age (OR 1.02 CI 1.02-1.03 P = .00), anaemia (OR 1.04 CI 1.59-1.91 P = .006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P = .00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P = .00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P = .00) and sepsis (OR 1.5, CI 4.1-5.08, P = .00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8 ± 14.9 vs 6.3 ± 8.5, P < .01) and mean total charges (37 054 $ vs 18 080 $, P < .01) were also higher. CONCLUSIONS In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation and shock requiring vasopressor. Mean LOS and resource utilisation were also higher.
Collapse
Affiliation(s)
- Pavani Garlapati
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| | - Bhavesh Gajjar
- Department of Medicine, Quillen College of Medicine, Johnson City, TN, USA
| | - Eric O Then
- Department of Gastroenetrology, The Brooklyn Hospital, Brooklyn, NY, USA
| | - Vijay Gayam
- Department of Medicine, Interfaith Medical Center, Brooklyn, NY, USA
| |
Collapse
|
|
7
|
Salani M, Golper T. When ESKD complicates disease management: GI bleeding and other GI illnesses. Semin Dial 2020; 33:263-269. [DOI: 10.1111/sdi.12874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Megha Salani
- Department of Nephrology Vanderbilt University Medical Center Nashville TN USA
| | - Thomas Golper
- Department of Nephrology Vanderbilt University Medical Center Nashville TN USA
| |
Collapse
|
|
8
|
Tariq T, Karabon P, Irfan FB, Goyal S, Mayeda MM, Parsons A, Judd S, Ehrinpreis M. Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample. World J Gastrointest Endosc 2019; 11:504-514. [PMID: 31798771 PMCID: PMC6885446 DOI: 10.4253/wjge.v11.i10.504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/21/2019] [Accepted: 09/11/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.
AIM To determine the nationwide prevalence, trends, predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.
METHODS The Nationwide Inpatient Sample database from 2009 to 2014, was utilized to conduct a retrospective study on patients with angiodysplasia associated- gastrointestinal bleeding and end-stage renal disease. Hospitalizations with end-stage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasia-associated gastrointestinal bleeding were identified with International Classification of Diseases, 9th revision, Clinical Modification codes for both end-stage renal disease (585.6) and Angiodysplasia (569.85, 537.83).
RESULTS The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45% (n = 24709) among all end-stage renal disease patients (n = 5505252) that were hospitalized. Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients: an increasing trend from 2009-2014 (P < 0.01), increasing age (P < 0.0001); African American race (P = 0.0206); increasing Charlson-Deyo Comorbidity Index (P < 0.01); hypertension (P < 0.0001); and tobacco use (P < 0.0001). Diabetes mellitus (P < 0.0001) was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients. In comparison with urban teaching hospitals, rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.
CONCLUSION Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014. Advanced age, African American race, overall high comorbidities, hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalized patients.
Collapse
Affiliation(s)
- Tooba Tariq
- Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, United States
| | - Patrick Karabon
- Oakland University William Beaumont School of Medicine, Oakland University, Detroit, MI 48309, United States
| | - Furqan B Irfan
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Sachin Goyal
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
| | - Matthew Masaru Mayeda
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Austin Parsons
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Stephanie Judd
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University and John D Dingell VA Medical Center, Detroit, MI 48201, United States
| | - Murray Ehrinpreis
- Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
| |
Collapse
|
|
9
|
Hsu CH, Hu HY, Huang N, Chang SS. Early eradication has a lower risk of peptic ulcer bleeding in Helicobacter pylori-infected chronic kidney disease patients. Eur J Intern Med 2016; 33:112-7. [PMID: 27449117 DOI: 10.1016/j.ejim.2016.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori (H. pylori) eradication therapy is necessary for H. pylori-infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage. METHODS AND PATIENTS Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB. RESULTS We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB. CONCLUSION Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori-infected CKD patients.
Collapse
Affiliation(s)
- Ching-Hui Hsu
- Division of Allergy, Immunology, Rheumatology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
| | - Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan; School of Medicine, National Yang-Ming University, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan.
| |
Collapse
|
|
10
|
Wang YU, Yuan C, Liu X. Characteristics of gastrointestinal hemorrhage associated with pancreatic cancer: A retrospective review of 246 cases. Mol Clin Oncol 2015; 3:902-908. [PMID: 26171204 DOI: 10.3892/mco.2015.563] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 12/21/2022] Open
Abstract
While gastrointestinal (GI) hemorrhage is common in the general population, few studies have evaluated large numbers of GI hemorrhage patients with pancreatic cancer. The clinical features and potential risk factors of GI hemorrhage with pancreatic cancer was investigated in the present study and the effect of GI hemorrhage on survival rate was examined. Patients enrolled in the present study had pathologically proven pancreatic cancer, and received treatment between August 2006 and 2012. Their medical records were retrospectively reviewed. The data for the present study were obtained from a review of 246 patients with pancreatic cancer (average age, 63.4±10.92 years; 190 male cases, 56 female cases). In addition, 73 cases had stage I-II, 173 had stage III-IV, and only 67 cases (27.2%) were candidates for curative pancreatectomy. Among them, 32 cases (13.0%) were clinically diagnosed with GI hemorrhage. A total of 24 cases were male patients and the other 8 cases were female, the cases of hemorrhage history and alcoholism were 2 and 29 cases, respectively. The major initial clinical symptoms of GI hemorrhage included 18 patients with melena or blood stool (56.25%), 9 with haematemesis (28.13%), 3 with abdominal distention (9.37%) and 2 with stomach ache (6.25%). The independent risk factor for GI hemorrhage was tumor initial stage of IV. A continuous increase in carbohydrate antigen 19-9 (CA19-9) may be a warning of GI hemorrhage, particularly when it is >1,000 U/ml. The most frequent method of hemostasis was combination therapy (n=12, 37.5%). Only 3 cases (9.3%) of these 32 GI hemorrhage patients were blood stanched and only 10 patients (31.2%) received gastroscopy. The time from GI hemorrhage to fatality is extremely short (median 30 days, range from 1 h to 65 days), and the median overall survival time of the patients with GI hemorrhage was 9.0 months (range, 2.0-16.0 months) and was significantly shorter than that of patients without GI hemorrhage [14.5 months (range, 0.5-48.0 months)]. In conclusion, although GI hemorrhage was not common in patients with pancreatic cancer, it is critical. GI hemorrhage was controlled with endoscopic hemostasis. Clinicians should fully assess the risk factors of GI hemorrhage (such as alcohol, smoking, past hemorrhage history, initial stage, tumor location and CA19-9 level at diagnosis of pancreatic cancer) when the pancreatic cancer patients were on admission, particularly for patients of the late stage, preventive measures should be investigated to reduce suffering.
Collapse
Affiliation(s)
- Y U Wang
- Department of Oncology, Graduate School of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Caijun Yuan
- Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| | - Xiaomei Liu
- Department of Oncology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning 121000, P.R. China
| |
Collapse
|
|
11
|
Lim H, Kim JH, Baik GH, Park JW, Kang HS, Moon SH, Park CK. Effect of low-dose proton pump inhibitor on preventing upper gastrointestinal bleeding in chronic kidney disease patients receiving aspirin. J Gastroenterol Hepatol 2015; 30:478-84. [PMID: 25252119 DOI: 10.1111/jgh.12780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIM Upper gastrointestinal bleeding (UGIB) leads to significant morbidity and mortality in chronic kidney disease (CKD) patients. This study determined the efficacy of using a low-dose proton pump inhibitor (PPI) to reduce the risk of non-variceal UGIB in CKD patients receiving aspirin. METHODS We retrospectively reviewed the medical records of 500 CKD patients who received aspirin between January 2008 and March 2013. Cumulative incidence analysis using the Kaplan-Meier method was performed to analyze the rate of non-variceal UGIB and association with the administration of low-dose PPI. RESULTS Of the 500 patients, 191 received low-dose PPI. Over the follow-up period, which lasted 1067 person-years, three patients in the low-dose PPI group (8.9 per 1000 person-years) and 19 patients in the non-PPI group (25.9 per 1000 person-years) developed non-variceal UGIB, respectively (P = 0.113). Low-dose PPI use did not decrease the risk of UGIB in CKD patients, including patients who did not receive dialysis (P = 0.127). However, according to the subgroup analysis of 230 patients who received dialysis, the low-dose PPI group (14.4 per 1000 person-years) demonstrated significantly reduced incidence and risk of non-variceal UGIB in comparison with the non-PPI group (53.8 per 1000 person-years) (P = 0.032). CONCLUSION Prophylactic low-dose PPI can reduce the risk of non-variceal UGIB in dialysis patients receiving aspirin.
Collapse
Affiliation(s)
- Hyun Lim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, South Korea
| | | | | | | | | | | | | |
Collapse
|
|
12
|
Trivedi H, Yang J, Szabo A. Gastrointestinal bleeding in patients on long-term dialysis. J Nephrol 2014; 28:235-43. [PMID: 25185727 DOI: 10.1007/s40620-014-0132-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/08/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The epidemiology of gastrointestinal bleeding (GIB) in end-stage renal disease (ESRD) has not been adequately characterized. Using United States Renal Data System data we investigated the epidemiology of GIB in hospitalized patients receiving long-term dialysis. METHODS Medicare ESRD patients who began dialysis between 1996 and 2005 were followed from 90 days after starting dialysis to death, transplant, loss of Medicare, or December 31, 2006. GIB events were identified using claims data. Predictors of GIB incidence were analyzed using over-dispersed Poisson regression and Cox regression was used to evaluate the effect on survival. Repeat episodes were modeled using a partially conditional Cox regression model. RESULTS 406,836 patients were followed for 832,131 person-years, during which 133,967 events were identified. The incidence of GIB was stable through year 2000 but steadily increased thereafter. Chronic gastric ulcer and colonic diverticulosis were the commonest defined causes of upper and lower GIB respectively. Age >49 years, female gender, hypertension as the cause of ESRD, and initiation on hemodialysis was associated with a greater risk of GIB. An episode of GIB conferred a increased hazard of death (hazard ratio 1.9, 95% CI 1.86-1.93). A previous episode of GIB was associated with greater hazard of another episode (hazard ratio 3.93, 95% CI 3.82-4.05). CONCLUSIONS In ESRD patients incident to long-term dialysis the incidence of hospital-associated GIB is increasing, is associated with a greater hazard of death, and carries a great hazard of repeat episodes.
Collapse
Affiliation(s)
- Hariprasad Trivedi
- Divison of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., CLCC 5220, Milwaukee, WI, 53226, USA,
| | | | | |
Collapse
|
|
13
|
Bang CS, Lee YS, Lee YH, Sung H, Park HJ, Kim HS, Kim JB, Baik GH, Kim YS, Yoon JH, Kim DJ, Suk KT. Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease. World J Gastroenterol 2013; 19:7719-7725. [PMID: 24282360 PMCID: PMC3837271 DOI: 10.3748/wjg.v19.i43.7719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/04/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage (NGIH) in patients with chronic kidney disease (CKD).
METHODS: From 2003 to 2010, a total of 72 CKD patients (male n = 52, 72.2%; female n = 20, 27.8%) who had undergone endoscopic treatments for NGIH were retrospectively identified. Clinical findings, endoscopic features, prognosis, rebleeding risk factors, and mortality-related factors were evaluated. The characteristics of the patients and rebleeding-related data were recorded for the following variables: gender, age, alcohol use and smoking history, past hemorrhage history, endoscopic findings (the cause, location, and size of the hemorrhage and the hemorrhagic state), therapeutic options for endoscopy, endoscopist experience, clinical outcomes, and mortality.
RESULTS: The average size of the hemorrhagic site was 13.7 ± 10.2 mm, and the most common hemorrhagic site in the stomach was the antrum (n = 21, 43.8%). The most frequent method of hemostasis was combination therapy (n = 32, 44.4%). The incidence of rebleeding was 37.5% (n = 27), and 16.7% (n = 12) of patients expired due to hemorrhage. In a multivariate analysis of the risk factors for rebleeding, alcoholism (OR = 11.19, P = 0.02), the experience of endoscopists (OR = 0.56, P = 0.03), and combination endoscopic therapy (OR = 0.06, P = 0.01) compared with monotherapy were significantly related to rebleeding after endoscopic therapy. In a risk analysis of mortality after endoscopic therapy, only rebleeding was related to mortality (OR = 7.1, P = 0.02).
CONCLUSION: Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic.
Collapse
|
|
14
|
Weng SC, Shu KH, Tarng DC, Tang YJ, Cheng CH, Chen CH, Yu TM, Chuang YW, Huang ST, Sheu WHH, Wu MJ. In-hospital mortality risk estimation in patients with acute nonvariceal upper gastrointestinal bleeding undergoing hemodialysis: a retrospective cohort study. Ren Fail 2013; 35:243-8. [PMID: 23336331 DOI: 10.3109/0886022x.2012.747140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Upper gastrointestinal bleeding (UGIB) is a major cause of clinical bleeding among patients with end-stage renal disease (ESRD). This study aimed to investigate the association between mortality and UGIB in patients with uremia. METHODS From 2004 to 2010, a tertiary hospital-based retrospective cohort comprising 322 patients undergoing hemodialysis was investigated. All the patients were diagnosed with UGIB according to the International Classification of Diseases, 9th Revision (ICD-9) that included peptic ulcer bleeding, duodenal ulcer bleeding, and other symptoms. UGIB was required to be one of the first three discharge diagnoses. Rehospitalization within 3 days after discharge was regarded as the same course. Exclusion criteria were age <20 years, previous gastric resection or vagotomy, esophageal and gastric variceal bleeding, or gastric cancer within the first 2 years of the index hospitalization. RESULTS The all-cause in-hospital mortality rate of patients with UGIB undergoing hemodialysis was high, with the first-month mortality rate of 13.7%, sixth-month mortality rate of 26.7%, and first-year mortality rate of 27.0%. Using Cox regression models, we found that the high mortality rate of the UGIB group was significantly correlated with older age [adjusted hazard ratio (HR) = 1.02, 95% confidence interval (CI) = 1.01-1.04], female sex (adjusted HR = 1.62, 95% CI = 1.05-2.51), infection during hospitalization (adjusted HR = 1.85, 95% CI = 1.13-3.03), single episodic UGIB (adjusted HR = 2.00, 95% CI = 1.08-3.70), abnormal white blood cell (WBC) count (adjusted HR = 1.59, 95% CI = 1.03-2.45), and albumin level ≤3 g/dL (adjusted HR = 2.67, 95% CI = 1.51-4.72). CONCLUSION In conclusion, patients with ESRD who are admitted with primary UGIB have a profoundly increased risk of all-cause in-hospital mortality during the follow-up period.
Collapse
Affiliation(s)
- Shuo-Chun Weng
- Center of Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
15
|
Mousavi M, Dashti-Khavidaki S, Khalili H, Farshchi A, Gatmiri M. Impact of clinical pharmacy services on stress ulcer prophylaxis prescribing and related cost in patients with renal insufficiency. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2012; 21:263-9. [DOI: 10.1111/ijpp.12005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 09/26/2012] [Indexed: 01/22/2023]
Abstract
Abstract
Objectives
Compared to the general population, chronic kidney disease patients are more vulnerable to gastrointestinal haemorrhage and its morbidity and mortality. Due to the fear of gastrointestinal bleeding consequences in these patients on the one hand, and the perception of general safety of acid suppressive medications on the other hand, inappropriate stress ulcer prophylaxis (SUP) seems to be encountered in nephrology wards. The objectives of this study were to evaluate appropriateness of acid suppression therapy in kidney disease patients and to assess the role of clinical pharmacists to decrease inappropriate SUP prescribing and related costs for these patients.
Methods
All inpatients at nephrology wards of a teaching hospital were assessed regarding appropriate SUP prescribing during a 6-month pre-intervention phase of the study without any clinical pharmacists' involvement in patients' management. Thereafter, during a 6-month post-intervention phase clinical pharmacists provided local SUP protocol and educational classes for physicians regarding appropriate SUP prescribing and participated actively in the patient-care team.
Main findings
The results showed significant relative reduction in inappropriate SUP prescribing and related cost in patients with renal insufficiency by about 44% and 67% respectively.
Conclusion
This study showed that implementing institutional guidelines, and active involvement of clinical pharmacists in the nephrology healthcare team, could reduce inappropriate SUP prescribing and related costs for these patients.
Collapse
Affiliation(s)
- Maryam Mousavi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Simin Dashti-Khavidaki
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Khalili
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Farshchi
- School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansoor Gatmiri
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
16
|
Lin SC, Wu KL, Chiu KW, Lee CT, Chiu YC, Chou YP, Hu ML, Tai WC, Chiou SS, Hu TH, Changchien CS, Chuah SK. Risk factors influencing the outcome of peptic ulcer bleeding in end stage renal diseases after initial endoscopic haemostasis. Int J Clin Pract 2012; 66:774-781. [PMID: 22650364 DOI: 10.1111/j.1742-1241.2012.02974.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background and Aims: Patients suffering from peptic ulcer (PU) bleeding who have end-stage renal disease (ESRD) may encounter more adverse outcomes. The primary objective is to investigate the risk factors that influence the outcomes of ESRD and chronic kidney disease (CKD) patients with PU bleeding after successful initial endoscopic haemostasis. Methods: A total of 540 patients with PU bleeding after initial endoscopic haemostasis in a tertiary hospital were investigated retrospectively. They were sorted into three groups after randomised age-matched adjustment: ESRD group (n = 90), CKD group (n = 90) and control group (n = 360). Main outcome measurements were rebleeding, requirement for blood transfusion and surgery, length of hospital stay and mortality. Results: The rebleeding rates were 43% for the ESRD group vs. 21% for the CKD group vs. 12% for the control group (overall p = < 0.001). Multivariate analysis showed the predictors of rebleeding were ESRD, time to endoscope, and non-high-dose proton-pump inhibitors (PPI) users. The risk factors for bleeding-related mortality were presence of moderate degree of CKD and ESRD group, time to endoscope, and Rockall score. All-cause mortality was related to presence of moderate degree of CKD and ESRD group, platelet count, time to endoscope, Rockall score and length of hospital stay. Conclusions: ESRD patients who suffered from PU bleeding were at risk of excessive rebleeding and mortality with frequent occurrence of delayed rebleeding. This study suggests that early endoscopy for initial haemostasis and high-dose intravenous PPI are associated with the reduction of rebleeding risk especially in patients with high Rockall scores.
Collapse
Affiliation(s)
- S-C Lin
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
17
|
A real world report on intravenous high-dose and non-high-dose proton-pump inhibitors therapy in patients with endoscopically treated high-risk peptic ulcer bleeding. Gastroenterol Res Pract 2012; 2012:858612. [PMID: 22844276 PMCID: PMC3403596 DOI: 10.1155/2012/858612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 05/13/2012] [Accepted: 05/21/2012] [Indexed: 01/25/2023] Open
Abstract
Background and Study Aims. The optimal dose of intravenous proton-pump inhibitor (PPI) therapy for the prevention of peptic ulcer (PU) rebleeding remains controversial. This study aimed to understand the real world experiences in prescribing high-dose PPI and non-high-dose PPI for preventing rebleeding after endoscopic treatment of high-risk PU. Patients and Methods. A total of 220 subjects who received high-dose and non-high-dose pantoprazole for confirmed acute PU bleeding that were successfully treated endoscopically were enrolled. They were divided into rebleeding (n = 177) and non-rebleeding groups (n = 43). Randomized matching of the treatment-control group was performed. Patients were randomly selected for non-high-dose and high-dose PPI groups (n = 44 in each group). Results. Univariate analysis showed, significant variables related to rebleeding were female, higher creatinine levels, and higher Rockall scores (≧6). Before case-control matching, the high-dose PPI group had higher creatinine level, higher percentage of shock at presentation, and higher Rockall scores. After randomized treatment-control matching, no statistical differences were observed for rebleeding rates between the high-dose and non-high-dose groups after case-control matching. Conclusion. This study suggests that intravenous high-dose pantoprazole may not be superior to non-high-dose regimen in reducing rebleeding in high-risk peptic ulcer bleeding after successful endoscopic therapy.
Collapse
|
|
18
|
Sood P, Kumar G, Nanchal R, Sakhuja A, Ahmad S, Ali M, Kumar N, Ross EA. Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol 2012; 35:216-24. [PMID: 22310659 DOI: 10.1159/000336107] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 12/29/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND The outcome of gastrointestinal bleeding in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients is difficult to discern from the literature. Many publications are small, single-center series or are from an era prior to advanced interventional endoscopy, widespread use of proton pump inhibitors or treatment for Helicobacter pylori infections. In this study, we quantify the role of CKD and ESRD as independent predictors of mortality in patients admitted to the hospital with a principal diagnosis of primary upper gastrointestinal bleeding (UGIB). METHODS We used the Nationwide Inpatient Sample that contains data on approximately 8 million admissions in 1,000 hospitals chosen to approximate a 20% stratified sample of all US facilities. Patients discharged with the principal diagnosis of primary UGIB, CKD or ESRD were identified through the ninth revision of the International Classification of Diseases, clinical modification (ICD-9-CM) codes. The outcome variables included frequency and in-hospital mortality of UGIB in CKD and ESRD patients as compared to non-CKD patients and were analyzed using logistic regression modeling. RESULTS In 2007, out of a total of 398,213 admissions with a diagnosis of primary UGIB, 35,985 were in CKD, 14,983 in ESRD, and 347,245 in non-renal disease groups. The OR for primary UGIB hospitalization in CKD and ESRD was 1.30 (95% CI 1.17-1.46) and 1.84 (95% CI 1.61-2.09), respectively. The corresponding all-cause mortality OR was 1.47 (95% CI 1.21-1.78) and 3.02 (95% CI 2.23-4.1), respectively. CONCLUSION Patients with CKD or ESRD admitted with primary UGIB have up to three times higher risk of all-cause in-hospital mortality, warranting heightened vigilance by their clinicians.
Collapse
Affiliation(s)
- Puneet Sood
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, USA.
| | | | | | | | | | | | | | | |
Collapse
|
|
19
|
Rodríguez-Lago I, Carretero C, Munoz-Navas M. Gastrointestinal bleeding caused by primary small bowel lymphoma in a patient who received a renal transplant. Clin Gastroenterol Hepatol 2012; 10:e2. [PMID: 21888884 DOI: 10.1016/j.cgh.2011.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/07/2011] [Accepted: 08/14/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Iago Rodríguez-Lago
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
| | | | | |
Collapse
|
|
20
|
Saeed F, Agrawal N, Greenberg E, Holley JL. Lower gastrointestinal bleeding in chronic hemodialysis patients. Int J Nephrol 2011; 2011:272535. [PMID: 22007297 PMCID: PMC3189573 DOI: 10.4061/2011/272535] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 07/07/2011] [Accepted: 07/10/2011] [Indexed: 01/29/2023] Open
Abstract
Gastrointestinal (GI) bleeding is more common in patients with chronic kidney disease and is associated with higher mortality than in the general population. Blood losses in this patient population can be quite severe at times and it is important to differentiate anemia of chronic diseases from anemia due to GI bleeding. We review the literature on common causes of lower gastrointestinal bleeding (LGI) in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. We suggest an approach to diagnosis and management of this problem.
Collapse
Affiliation(s)
- Fahad Saeed
- Department of Nephrology and Hypertension, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | | | | |
Collapse
|
|
21
|
Liang CC, Wang IK, Lin HH, Yeh HC, Liu JH, Kuo HL, Hsu WM, Huang CC, Chang CT. Prophylactic use of omeprazole associated with a reduced risk of peptic ulcer disease among maintenance hemodialysis patients. Ren Fail 2011; 33:323-8. [PMID: 21401358 DOI: 10.3109/0886022x.2011.560407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Patients undergoing maintenance hemodialysis (MHD) have a high prevalence of peptic ulcer disease (PUD). Omeprazole is a proton pump inhibitor with proven efficacy in the prevention and treatment of PUD. However, there is little data on the prophylactic use of omeprazole in reducing the risk of PUD among MHD patients. METHODS This prospective study included 93 patients undergoing MHD at Zen-Ho Dialysis Center between July 2008 and December 2009. Fifty-three patients were assigned to receive 20 mg of omeprazole daily for 18 months and 40 patients served as control. The Kaplan-Meier method was applied to calculate the cumulative incidence of PUD. RESULTS The per-protocol population comprised 85 patients (omeprazole group, 49; control group, 36). Both groups had similar baseline characteristics. The need for endoscopy was found to be significantly less (10.2 vs. 44.4%, p = 0.001) in the omeprazole group than in the control group. Dialysis patients in the omeprazole group required fewer blood transfusions and erythropoietin doses than did the control group patients. Kaplan-Meier analysis revealed a higher cumulative ulcer rate in the control group (log-rank test, p = 0.04). However, omeprazole did not reduce the risk of PUD in MHD patients on regular aspirin or warfarin. CONCLUSIONS We conclude that prophylactic use of omeprazole might be effective to lower the incidence of PUD among MHD patients without regular aspirin or warfarin use. Further large-scale controlled trials should be carried out to confirm our findings.
Collapse
Affiliation(s)
- Chih-Chia Liang
- Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|