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Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease
Justin Cheung1, Andrea Yu, Joseph LaBossiere
1Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Background:
Patients with end-stage renal disease (ESRD) and peptic ulcer disease (PUD) bleeding may be at high risk of bleeding complications.
Objective:
To investigate the outcomes of patients with ESRD and PUD bleeding.
Design:
ESRD patients with PUD bleeding were evaluated retrospectively.
Setting:
Two tertiary, university-affiliated hospitals.
Patients:
A total of 150 PUD bleeding patients were evaluated in 3 groups; end-stage renal disease (ESRD) patients on dialysis (ESRD group) (n = 50) were age matched with patients with chronic kidney disease (CKD) not requiring dialysis (CKD group) (n = 50) and those with normal kidney function (normal group) (n = 50).
Main Outcome Measurements:
Rebleeding, transfusions, length of hospitalization, mortality.
Results:
Multivariate analysis showed significant predictors of rebleeding to be ESRD and high-risk stigmata. The ESRD group had an odds ratio (OR) of 3.8 (95% CI, 1.4-10.5; P = .008) for rebleeding compared with the normal group, and an OR of 3.8 (95% CI, 1.4-10.3; P = .01) compared with the CKD group. The mean number of (+/- SD) transfusions was higher in the ESRD group (6.3 +/- 5.7 units) than in the normal group (3.6 +/- 3.9 units; P = .01). The mean length of hospitalization was higher in the ESRD group than in the normal group (34.0 vs 16.6 days; P = .01). A greater level of comorbidity was the only significant predictor of mortality (OR 6.0; 95% CI, 2.9-12.3; P = .001).
Limitation:
Retrospective study.
Conclusion:
ESRD dialysis patients with PUD bleeding have greater rebleeding than patients not on dialysis. ESRD patients should be managed as a high-risk group.
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