Kidney Week

Abstract: FR-PO0405

A Bleeding Problem: Incidence of Major Gastrointestinal Bleeding and Associated Mortality

Session Information

• Dialysis: Measuring and Managing Symptoms and Syndromes
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Jiao, Yue, Renal Research Institute, New York, New York, United States

Yue Jiao, PhD

• Larkin, John W., Renal Research Institute, New York, New York, United States

John W. Larkin, PhD

• Blankenship, Derek, Renal Research Institute, New York, New York, United States

Derek Blankenship, PhD, MBA

• Lama, Suman Kumar, Renal Research Institute, New York, New York, United States

Suman Kumar Lama, MS, MSc

• Winter, Anke, Renal Research Institute, New York, New York, United States

Anke Winter, MD

• Chaudhuri, Sheetal, Renal Research Institute, New York, New York, United States

Sheetal Chaudhuri, PhD

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

Manuela Stauss-Grabo, PhD

• Usvyat, Len A., Renal Research Institute, New York, New York, United States

Len A. Usvyat, PhD

• Maddux, Franklin W., Fresenius Medical Care AG, Bad Homburg, HE, Germany

Franklin W. Maddux, MD

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

David C. Wheeler, MD

• Stenvinkel, Peter, Karolinska Institutet, Stockholm, Stockholm County, Sweden

Peter Stenvinkel, MD, PhD

• Floege, Jürgen, University Hospital RWTH Aachen, Divisions of Nephrology and Cardiology, Aachen, Germany

Jürgen Floege, MD

Group or Team Name

• On behalf of the INSPIRE Core Group.

Background

Gastrointestinal bleeding (GIB) is the most common bleeding event in dialysis patients, but population-level incidence and mortality are unknown. We characterized GIB hospitalization rates and associated mortality using a nationally representative US dialysis cohort.

Methods

We analyzed data (Jan 2018-Mar 2021) from adults (≥18 years) treated with dialysis ≥30 days in a kidney care network. Those starting dialysis after Jan 2021 were excluded to ensure ≥3 month follow up. GIB hospitalizations were identified using ICD codes from discharge diagnoses (primary-tertiary). We calculated GIB hospitalization incidence per 1,000 person-years (p1000py) (excluding GIB admission time) and mortality per 100 person-years (p100py) within 30, 60, 90 days, and anytime after GIB events.

Results

Among 366,839 adults on dialysis (mean age 62.6 years, vintage 2.27 years, 57.7% male), 25,057 patients (6.8%) experienced GIB hospitalization, including 18,407 (73.5%) with a single event and 6,650 (26.5%) with recurrent events. Incidence rate of GIB hospitalization was 52.6 p1000py (95% CI: 52.1–53.1). In total, 11,224 patients (44.8%) died after GIB hospitalization, with a mortality rate of 20.2 p100py (95% CI: 19.8–20.6). Mortality rates were consistent by lesion location: 18.6 p100py (95% CI: 17.9–19.4) for upper GIB, 19.4 p100py (95% CI: 18.5–20.4) for lower GIB, and 21.0 p100py (95% CI: 20.5–21.4) for unspecified GIB location. Figure 1 shows case fatality after GIB hospitalization.

Conclusion

Major GIB hospitalization occurs in about 53 per 1000 dialysis patients annually, with a mortality rate of 20%. The general population shows a GIB hospitalization rate of 0.9 per 1000 people and a mortality rate of 1.1%. Dialysis patients have a 50-fold higher GIB hospitalization rate and a 20-fold higher mortality rate compared to the general population, highlighting a unmet need for further research.

Figure 1: Case Fatality Rate after GI Bleeding (GIB) Hospitalization Per 100 Person-Years

Funding

• Commercial Support – Fresenius Medical Care

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20258g2hp0p8