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Nonpeptic Ulcer, Nonvariceal Gastrointestinal Bleeding in Hemodialysis Patients

  • Jiing-Chyuan Luo
    Correspondence
    Requests for reprints should be addressed to Jiing-Chyuan Luo, MD, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, #201 Shih-Pai Road, Section 2, Taipei 11217, Taiwan
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Hsin-Bang Leu
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Ming-Chih Hou
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan

    Endoscopic Center for Diagnosis and Therapy, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Kuang-Wei Huang
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Han-Chieh Lin
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Fa-Yauh Lee
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Wan-Leong Chan
    Affiliations
    Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan

    Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shing-Jong Lin
    Affiliations
    Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Jaw-Wen Chen
    Affiliations
    Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan

    Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan

    Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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      Abstract

      Objectives

      Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation.

      Methods

      Using Taiwan's National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis.

      Results

      A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients.

      Conclusions

      There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.

      Keywords

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