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Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide
Tzung-Jiun Tsai1,2, Wen-Chi Chen1,2, Yu-Tung Huang3
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Insights
Patients undergoing hemodialysis have an increased risk of lower gastrointestinal bleeding and angiodysplasia bleeding. This finding highlights a critical concern for chronic kidney disease management and patient safety.
Area of Science:
- Nephrology
- Gastroenterology
- Epidemiology
Background:
- Chronic kidney disease (CKD) is associated with an increased risk of gastrointestinal (GI) bleeding.
- Previous research has indicated that hemodialysis may elevate the risk of gastroduodenal ulcers.
- Limited studies have explored the specific link between CKD and lower GI bleeding.
Purpose of the Study:
- To investigate the association between chronic kidney disease (CKD), hemodialysis, and the incidence of lower gastrointestinal bleeding.
- To identify risk factors contributing to lower GI bleeding in patients with varying stages of CKD.
Main Methods:
- An observational cohort study design was employed.
- Data were sourced from Taiwan's National Health Insurance Research Database, sampling 1 million individuals.
- End-stage renal disease (ESRD) patients on hemodialysis (dialysis CKD), CKD patients not on dialysis (dialysis-free CKD), and control subjects were matched by age, sex, and comorbidities in a 1:2:2 ratio.
- Cox proportional hazard regression models were utilized to analyze risk factors for lower GI bleeding.
Main Results:
- Dialysis CKD patients exhibited a significantly higher incidence of lower GI bleeding compared to dialysis-free CKD patients (P < 0.001).
- Multivariate analysis identified extreme old age (≥85 years), male gender, dialysis-free CKD, and dialysis CKD as independent risk factors for lower GI bleeding.
- Dialysis CKD patients also showed a higher incidence of angiodysplasia bleeding (1.1%) compared to dialysis-free CKD patients (0.1%) and controls (0.1%) (both P < 0.001).
Conclusions:
- Hemodialysis treatment is associated with an elevated risk of lower GI bleeding.
- Patients undergoing hemodialysis may also face a higher risk of angiodysplasia bleeding.
- Age, gender, and CKD status (with or without dialysis) are significant independent factors influencing lower GI bleeding risk.
Background:
Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding.
Results:
Dialysis CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both.
Conclusion:
Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.
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