Risk and Outcome of Acute Nonvariceal Upper Gastrointestinal Bleeding among Patients on Dialysis: A Nationwide Population-Based Study in Taiwan

摘要

BACKGROUND: Impaired kidney function is associated with increased risk for acute nonvariceal upper gastrointestinal bleeding (ANVUGIB) and higher mortality after the event. However, there were limited large-scaled population-based studies to compare risk for ANVUGIB between dialysis patients and general population.METHODS: We analyzed data from National Health Insurance Research Database (NHIRD), a nationwide claims data of 99% population in Taiwan. We defined dialysis patients from the catastrophic illness dataset (HV) in 2010 and used Longitudinal Health Insurance Database in 2010 (LHID 2010) as the control group. We identified all ANVUGIB episodes and comorbidities by validated algorithms. We used Poisson regression with generalized estimating equations methods to model the relative risk for ANVUGIB with adjustments for demographic characteristics and comorbid conditions. RESULTS: We identified 2,368 events among 60,476 patients on hemodialysis (HD), 133 events in 5,341 patients on peritoneal dialysis (PD) and 4,230 events among 808,879 controls. The crude occurrence rates for ANVUGIB were 45.4 (95% CI: 43.5 ~ 47.2), 31.6 (95% CI: 26.2 ~ 36.9) and 5.9 (95% CI: 5.8 ~ 6.1) events per 1,000 person ~ years for patients on HD, PD and controls respectively. The adjusted relative risks for ANVUGIB were 3.3 (95% CI: 3.1 ~ 3.5) and 3.5 (95% CI: 2.8 ~ 4.3) for patients on HD and PD, comparing to the general population.Compared to the general population, ANVUGIB episodes of patients on dialysis were more likely to be recurrent, hospitalized and requiring component therapy. Overall 30 ~ day mortality was 5.2% (95% CI: 4.3 ~ 6.1%) and 3.8% (95% CI: 0.5 ~ 7.0%) after the event among patients on HD and PD respectively. CONCLUSIONS: Patients on dialysis were at significantly higher risk for ANVUGIB after adjustments for age and comorbidities.