Kidney Week

Abstract: PUB113

Mortality After Gastrointestinal Bleeding Among Dialysis Patients

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

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, Waltham, Massachusetts, United States

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

Gastrointestinal bleeding (GIB) is common in patients on chronic dialysis, yet associated outcomes are uncertain. The INSPIRE group used data on a nationally representative sample of dialysis patients to characterize the mortality rate after a GIB episode.

Methods

We used data on adult dialysis patients treated at a provider network in the United States during Jan-2018 to Mar-2021 who had ≥1 GIB episode. GIB episodes were identified from ICD diagnosis codes recorded as a comorbid condition during dialysis care, or as a discharge reason for hospitalization (Zhao et al., AHRQ 2006). Crude mortality rate was calculated considering death anytime, or 365 days, after the first GIB.

Results

Among a population of 405,530 patients, 31,084 (7.7%) had ≥1 GIB episode. Crude mortality rate any time after the first GIB was 43.7% (n=13,573; Figure 1A). Mortality rate after the first GIB comorbidity (40.1%, n=2,435/6,068) was slightly lower than after the first GIB hospitalization (44.5%, n=11,138/25,016). Mortality rate increased with older age and appeared to be highest among patients with an unknown race, followed by a white race (42.3%; Figure 1B). Limiting the analysis to the 365 days after the first GIB, mortality rate was 32.2% after any GIB, 19.2% after a GIB comorbidity, and 36.0% after a GIB hospitalization.

Conclusion

Mortality rate after a GIB is high in dialysis patients, with 30% dying within a year and 40% dying anytime during follow-up. Mortality rates were higher after GIB hospitalization versus comorbidity, albeit exceedingly high in both cases. Further analyses are needed and should consider adjustments for age, race, and modality, and comparison to patients who never had a GIB.

Funding

• Commercial Support – Fresenius Medical Care