Patients with chronic kidney disease (CKD) who had peptic ulcer bleeding (PUB) may have more adverse outcomes. This population-based cohort study aimed to identify risk factors that may influence the outcomes of patients with CKD and PUB after initial endoscopic hemostasis. Data from 1997 to 2008 were extracted from the National Health Insurance Research Database in Taiwan. We included a cohort dataset of 1 million randomly selected individuals and a dataset of patients with CKD who were alive in 2008. A total of 18,646 patients with PUB were screened, and 1229 patients admitted for PUB after endoscopic hemostasis were recruited. The subjects were divided into non-CKD (n = 1045) and CKD groups (n = 184). We analyzed the risks of peptic ulcer rebleeding, sepsis events, and mortality among in-hospital patients, and after discharge. Results showed that the rebleeding rates associated with repeat endoscopic therapy (11.96% vs 6.32%, P = 0.0062), death rates (8.7%, vs 2.3%, P < 0.0001), hospitalization cost (US$ 5595±7200 vs US$2408 ± 4703, P < 0.0001), and length of hospital stay (19.6 ± 18.3 vs 11.2 ± 13.1, P < 0.0001) in the CKD group were higher than those in the non-CKD group. The death rate in the CKD group was also higher than that in the non-CKD group after discharge. The independent risk factor for rebleeding during hospitalization was age (odds ratio [OR], 1.02; P = 0.0063), whereas risk factors for death were CKD (OR, 2.37; P = 0.0222), shock (OR, 2.99; P = 0.0098), and endotracheal intubation (OR, 5.31; P < 0.0001). The hazard ratio of rebleeding risk for aspirin users after discharge over a 10-year follow-up period was 0.68 (95% confidence interval [CI]: 0.45–0.95, P = 0.0223). On the other hand, old age (P < 0.0001), CKD (P = 0.0090), diabetes (P = 0.0470), and congestive heart failure (P = 0.0013) were the independent risk factors for death after discharge. In-hospital patients with CKD and PUB after endoscopic therapy had higher recurrent bleeding, infection, and mortality rates, and the need for second endoscopic therapy. Age was the independent risk factor for recurrent bleeding during hospitalization. After being discharged with a 10-year follow-up period, nonaspirin user was a significant factor for recurrent bleeding.
aDivision of Hepatogastroenterology, Department of Internal Medicine
bDepartment of Pharmacy, Kaohsiung Gang Gung Memorial Hospital, Kaohsiung
cSchool of Pharmacy, Kaohsiung Medical University, Kaohsiung
dChang Gung University, College of Medicine, Kaohsiung
eDivision of Hepatogastroenterology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi
fDivision of Gastroenterology, Fu-Ying University Hospital, Pin-Tung
gDivisions of Gastroenterology, Yuan General Hospital, Kaohsiung
hDivision of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, and Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung
iDivision of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, Kaohsiung
jDivision of Gastroenterology; Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
kDivision of Gastroenterology; Pin-Tung Christian Hospital, Pin-Tung, Taiwan.
Correspondence: Seng-Kee Chuah and Deng-Chyang Wu, Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung 833, Taiwan (e-mails: email@example.com and firstname.lastname@example.org).
Abbreviations: ASA = aspirin, CKD = chronic kidney disease, ESRD = end-stage renal disease, H pylori = Helicobacter pylori, H2RA = H2 receptor antagonists, NHRID = National Health Research Institute database, NSAID = nonsteroid anti-inflammatory drugs, PPIs = proton pump inhibitors, PUB = peptic ulcer bleeding, PUD = peptic ulcer disease, SD = standard deviation, TAE = transarterial embolization.
SKC and DCW studied the concept and the design, did the acquisition of data, analyzed and interpreted the data, drafted the manuscript, and did critical revision of the manuscript for important intellectual content. CML did the acquisition of the data, analyzed and interpreted the data, drafted the manuscript, and did statistical analysis. CNH did the acquisition the data and analyzed and interpreted the data. WCT, SCY, CKW, CWS, MKK, LTY, JWW, KLT, WCS, THH, SHN, and PIH provided the administrative, technical, or material support.
The authors have no conflicts of interest to declare.
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
Received November 26, 2015
Received in revised form April 24, 2016
Accepted August 11, 2016