Different peptic ulcer bleeding risk in chronic kidney disease and end-stage renal disease patients receiving different dialysis

Kuang-Wei Huang, Hsin-Bang Leu, Jiing-Chyuan Luo, Wan-Leong Chan, Ming-Chih Hou, Han-Chieh Lin, Fa-Yauh Lee, Yi-Chun Kuan
Digestive Diseases and Sciences 2014, 59 (4): 807-13

BACKGROUND: End stage renal disease (ESRD) patients receiving hemodialysis (HD) have a higher risk of peptic ulcer bleeding (PUB).

AIMS: Whether ESRD patients receiving peritoneal dialysis (PD) also carries a higher risk of PUB has not been studied.

METHODS: This was a cohort study using Taiwan's National Health Insurance research database, whereby 11,408 patients, including 2,239 PD, 2,328 HD, 2,267 chronic kidney disease (CKD) and 4,574 controls with age-sex matching were recruited. The log-rank test was used to analyze differences in accumulated PUB-free survival rates between groups. Cox proportional hazard regression was performed to evaluate independent risk factors for PUB in all the enrollees.

RESULTS: During the 7-year follow-up, PD and CKD patients had a significantly higher rate of PUB than matched controls. The risk of PUB between PD and CKD was not significantly different. Moreover, patients receiving HD carried a higher risk of PUB than those receiving PD, with CKD and controls (p all <0.05, by log-rank test). Cox proportional hazard regression analysis showed that CKD (HR 3.99, 95 % CI 2.24-7.13), PD (HR 3.71, 95 % CI 2.00-6.87) and HD (HR 11.96, 95 % CI 7.04-20.31) were independently associated with an increased risk of PUB. Being elderly, male, having hypertension, diabetes, cirrhosis, and nonsteroidal anti-inflammatory drugs and steroid use were other independent risk factors of PUB in all enrollees.

CONCLUSIONS: Patients with CKD and ESRD receiving PD or HD carried a higher risk for PUB. They should be screened for risk factors for PUB and receive some protective measures to prevent PUB.

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