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

Authors

Rajat Garg, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
Malav P Parikh, Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
Pravallika Chadalvada, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
Amandeep Singh, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
Krishna Sanaka, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
Keerat R. Ahuja, Department of Cardiology, Tower Health, Philadelphia, Pennsylvania, USAFollow
Manik Aggarwal, Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
Rajesh Veluvolu, Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
Shivakumar Vignesh, Department of Gastroenterology, SUNY Downstate Health Sciences University, New York, New York, USA
Tarun Rustagi, Department of Gastroenterology, University of New Mexico, Albuquerque, New Mexico, USA

Document Type

Article

Publication Date

1-5-2022

Abstract

BACKGROUND AND AIM: Patients with end-stage renal disease (ESRD) on hemodialysis are considered to be at higher risk of gastrointestinal bleeding (GIB) as compared with 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 with NRD. ESRD patients were less likely to undergo endoscopic evaluation compared with NRD (P < 0.001). Late endoscopy (> 48 h) was associated with increased need for transfusion and health-care utilization but without a significant difference in mortality as compared with 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: End-stage renal disease patients with GIB had a significantly higher rate of mortality and a higher health-care utilization with a lower rate of endoscopic evaluation. Endoscopy was associated with a lower mortality rate on multivariate analysis.

Publication Title

Journal of gastroenterology and hepatology

Comments

Online ahead of print.

Recommended Citation

Garg, R., Parikh, M., Chadalvada, P., Singh, A., Sanaka, K., Ahuja, K. R., Aggarwal, M., Veluvolu, R., Vignesh, S., & Rustagi, T. (2022). Lower rates of endoscopy and higher mortality in end-stage renal disease patients with gastrointestinal bleeding: A propensity matched national study.. Journal of gastroenterology and hepatology https://doi.org/DOI: 10.1111/jgh.15771