Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

Tzung-Jiun Tsai; Wen-Chi Chen; Yu-Tung Huang; Yi-Hsin Yang; I-Che Feng; Wen-Chieh Wu; Huang-Ming Hu; Deng-Chyang Wu; Ping-I Hsu

doi:10.1155/2020/7206171

Hemodialysis Increases the Risk of Lower Gastrointestinal Bleeding and Angiodysplasia Bleeding: A Nationwide Population Study

Gastroenterol Res Pract. 2020 Mar 3:2020:7206171. doi: 10.1155/2020/7206171. eCollection 2020.

Authors

Tzung-Jiun Tsai^{1

2}, Wen-Chi Chen^{1

2}, Yu-Tung Huang³, Yi-Hsin Yang⁴, I-Che Feng⁵, Wen-Chieh Wu⁶, Huang-Ming Hu⁷, Deng-Chyang Wu⁷, Ping-I Hsu⁸

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
² National Yang-Ming University, Taipei, Taiwan.
³ Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taiyuan, Taiwan.
⁴ Center for Medical Informatics and Statistics, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁵ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
⁶ Division of GERD Center, Yuan Sheng Hospital, Changhua, Taiwan.
⁷ Division of Gastroenterology & Hepatology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁸ Department of Medicine, An Nan Hospital, China Medical University, Taiwan.

Abstract

Background: Patients with chronic kidney disease (CKD) with or without hemodialysis were considered to have bleeding tendency and higher risk for gastrointestinal (GI) bleeding. Previous studies had documented that hemodialysis may increase the gastroduodenal ulcer bleeding. Few studies evaluated the relationship between CKD and lower GI bleeding. Materials and Methods. An observational cohort study design was conducted. The end-stage renal disease (ESRD) patients receiving regular hemodialysis (dialysis CKD), CKD patients without dialysis (dialysis-free CKD), and controls were selected from 1 million randomly sampled subjects in the National Health Insurance Research Database of Taiwan. These three group subjects were matched by age, sex, comorbidity, and enrollment time in a 1 : 2 : 2 ratio. The Cox proportional hazard regression models were used to identify the potential risk factors for lower gastrointestinal bleeding.

Results: Dialysis CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (n = 574) had a higher incidence of lower GI bleeding than dialysis-free CKD patients (P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both P < 0.001). Multivariate analysis showed that extreme old age (age ≥ 85), male gender, dialysis-free CKD, and dialysis CKD were independent factors of lower GI bleeding. Additionally, dialysis CKD patients also had a higher incidence of angiodysplasia bleeding compared to dialysis-free CKD patients and control subjects (1.1% vs. 0.1% and 0.1%, respectively; both.

Conclusion: Hemodialysis may have higher risk of lower GI bleeding and angiodysplasia bleeding.