Kidney Week

Abstract: FR-PO830

Gastrointestinal Bleeding Types and Associated Mortality Rates in Dialysis Patients

Session Information

• Health Maintenance, Nutrition, Metabolism - II
  November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Alejos, Belen, Fresenius Medical Care, Bad Homburg, Germany

Belen Alejos,

• Jiao, Yue, Fresenius Medical Care, Waltham, Massachusetts, United States

Yue Jiao,

• Wolf, Melanie, Fresenius Medical Care, Bad Homburg, Germany

Melanie Wolf,

• Larkin, John W., Fresenius Medical Care, Waltham, Massachusetts, United States

John W. Larkin,

• Winter, Anke, Fresenius Medical Care, Bad Homburg, Germany

Anke Winter,

• Chaudhuri, Sheetal, Fresenius Medical Care, Bad Homburg, Germany

Sheetal Chaudhuri,

• Stauss-Grabo, Manuela, Fresenius Medical Care, Bad Homburg, Germany

Manuela Stauss-Grabo,

• Usvyat, Len A., Fresenius Medical Care, Waltham, Massachusetts, United States

Len A. Usvyat,

• Hymes, Jeffrey L., Fresenius Medical Care, Waltham, Massachusetts, United States

Jeffrey L. Hymes,

• Maddux, Franklin W., Fresenius Medical Care AG & Co KGaA, Bad Homburg, Hessen, Germany

Franklin W. Maddux,

• Wheeler, David C., University College London, London, United Kingdom

David C. Wheeler,

• Stenvinkel, Peter, Dept of Renal Medicine Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden

Peter Stenvinkel,

• Floege, Jürgen, University Hospital RWTH Aachen, Division of Nephrology and Clinical Immunology, Aachen, Germany

Jürgen Floege,

Group or Team Name

• On Behalf of the INSPIRE Core Group.

Background

The incidence of gastrointestinal bleeding (GIB) is ~7-fold higher in the dialysis vs general population. The INSPIRE collaborative group has aimed to describe mortality after a GIB episode by the type of bleed among chronic dialysis patients treated at a national provider in the United States (US).

Methods

We used data from adult dialysis patients who had ≥1 GIB episode between Jan-2018 to Mar-2021. GIB episodes were defined from ICD codes for comorbidities, or hospital discharge. We calculated crude mortality rates any time after the first GIB by type (upper or lower; Zhao et al., AHRQ 2006). GIB episodes with an unspecified location were not included in the analysis of GIB types.

Results

The incidence of a patient having ≥1 GIB episode was 7.7% (31,084/405,530). Overall, GIB was most common in patients between ages of 45-64 years (38.9%) & 65-75 years (28.7%), males (56.0%), and those of a white race (54.5%). GIB location was specified for 39.1% of the first GIB episodes. Demographics for patients with and without a specified GIB location did not differ. Crude mortality rate after the first GIB was 41.9% (n=3,392) for upper GIB and 42.3% (n=1,722) for lower GIB. Mortality rate for both GIB types was positively associated with age, and was the highest for patients with missing data on race (10.4% of cohort), followed by white race (Figure 1).

Conclusion

Mortality rate after the first GIB episode in a dialysis patient was >40%, regardless of the location of bleeding. Age and race specific differences were consistent for upper and lower GIBs. Most GIB episodes were classified as an unspecified type, suggesting the need for improvements in evaluation/coding. Further adjusted analyses are needed to confirm these results and understand the differences by dialysis modalities, risk factors, and causes of mortality.

Funding

• Commercial Support – Fresenius Medical Care