Lower rates of endoscopy and higher mortality in end-stage renal disease patients with gastrointestinal bleeding: A propensity matched national study

Link to article at PubMed

J Gastroenterol Hepatol. 2022 Jan 5. doi: 10.1111/jgh.15771. Online ahead of print.


BACKGROUND: Patients with end-stage renal disease (ESRD) on hemodialysis are considered to be at higher risk of gastrointestinal bleeding (GIB) as compared to those without renal disease (NRD). We conducted a population-based study using the National Inpatient Sample (NIS) database to study the outcomes of GIB in ESRD.

METHODS: Patients admitted with GIB (upper and lower) from 2005 to 2013 were extracted from the NIS database using ICD-9 codes. Patients were divided into NRD and ESRD groups and a 1:1 propensity matched analysis was performed. Various outcomes were compared in both groups and subgroup analysis based on the timing of endoscopy was also performed.

RESULTS: A total of 218,032 patients were included in the study. There was an increase in inpatient admissions among ESRD patients with GIB with significant reduction in mortality (p<0.001). In-hospital mortality, length of stay, and total costs were significantly higher in ESRD patients as compared to NRD. ESRD patients were less likely to undergo endoscopic evaluation compared to NRD (p<0.001). Late endoscopy (>48 hours) was associated with increased need for transfusion and healthcare utilization but without a significant difference in mortality as compared to early endoscopy. On multivariate analysis, endoscopy was associated with significantly lower rate of mortality in ESRD patients with GIB (Odds ratio 0.28, p <0.0001).

CONCLUSION: ESRD patients with GIB had a significantly higher rate of mortality and a higher healthcare utilization with a lower rate of endoscopic evaluation. Endoscopy was associated with a lower mortality rate on multivariate analysis.

PMID:34989024 | DOI:10.1111/jgh.15771

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