Risk factors of gastrointestinal bleeding for end-stage renal disease patients

Oh, Hyung Jung; Kim, Seung Jun; Park, Sun Young; Yoo, Dong Eun; Lee, Han Sung; Ku, Nam Su; Moon, Ji Ae; Kim, Dong Ki; Lee, Tae Hee; Moon, Sung Jin; Han, Seung Heok; Lee, Jeung Eun; Choi, Hoon Young; Han, Dae Suk; Kang, Shin Wook

Abstract

BACKGROUDN: Gastrointestinal bleeding (GIB) is not a rare complication in end-stage renal disease (ESRD) patients on dialysis and the occurrence of GIB has also been associated with higher morbidity and mortality rates. However, reasons for the high incidence of GIB are not clear. This retrospective study was undertaken not only to analyze the clinical features of GIB but also to elucidate the independent risk factors for GIB in Korean ESRD patients.
METHODS
One hundred thirty ESRD patients on dialysis at the Severance Hospital of Yonsei University College of Medicine from January 2000 to December 2005 were included in the study. The patients were divided into two groups: 65 patients with GIB (the GIB group) and 65 age-, sex-, and dialysis modality-matched patients without GIB (the C group). Clinical characteristics, medications, and laboratory findings were compared between the two groups.
RESULTS
Compared to the C group, congestive heart failure (40.0% vs. 21.5%, p<0.05), coronary arterial occlusive disease (CAOD) (32.3% vs. 4.6%, p<0.005), and nonsteroidal anti-inflammatory drug (NSAID) use (18.4% vs. 1.5%, p<0.01) were significantly more common in the GIB group. The baseline serum albumin levels were significantly lower in the GIB group than in the C group (2.53+/-0.67 g/dL vs. 3.56+/-0.63 g/dL, p<0.005). Using logistic regression analysis, CAOD (OR=23.0), NSAID use (OR=12.5), and lower serum albumin levels (OR=2.9) were identified as independent risk factors for GIB (p<0.05).
CONCLUSIONS
Careful attention must be paid to ESRD patients with CAOD, taking NSAIDs, or with low serum albumin levels in view of GIB.