Abstract: TH-PO0508
Short-Term Mortality in Patients on Dialysis with Gastrointestinal Bleeding in Connection with Antiplatelets, Proton-Pump Inhibitors, and Anticoagulants
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Sarisen, Michael, Renal Research Institute, New York, New York, United States
- Jiao, Yue, Renal Research Institute, New York, New York, United States
- Larkin, John W., Renal Research Institute, New York, New York, United States
- Blankenship, Derek, Renal Research Institute, New York, New York, United States
- Lama, Suman Kumar, Renal Research Institute, New York, New York, United States
- Winter, Anke, Renal Research Institute, New York, New York, United States
- Chaudhuri, Sheetal, Renal Research Institute, New York, New York, United States
- Stauss-Grabo, Manuela, Fresenius Medical Care Deutschland GmbH, Bad Homburg, HE, Germany
- Usvyat, Len A., Renal Research Institute, New York, New York, United States
- Maddux, Franklin W., Fresenius Medical Care AG, Bad Homburg, HE, Germany
- Wheeler, David C., University College London, London, England, United Kingdom
- Stenvinkel, Peter, Karolinska Universitetssjukhuset, Stockholm, Stockholm County, Sweden
- Floege, Jürgen, University Hospital RWTH Aachen, Divisions of Nephrology and Cardiology, Achen, Germany
Group or Team Name
- On behalf of the INSPIRE Core Group.
Background
Gastrointestinal bleeding (GIB) is a significant cause of mortality in dialysis patients. While overall incidence is described, less is known about how medications associated with a known bleeding risk impact GIB outcome and mortality. This study examines short-term mortality following GIB hospitalization in relation to antiplatelets, proton pump inhibitors (PPIs), and anticoagulants.
Methods
We assessed adult patients on dialysis with GIB hospitalizations between January 2018 and March 2021 using data from a large US kidney care network. Medications at baseline included antiplatelets, PPIs, Warfarin, and DOACs (Direct Oral Anticoagulants). Mortality rates were calculated per 100 person-years (p100py) following GIB hospitalization, stratified by GIB lesion location (upper, lower, unspecified) and medication class.
Results
Among 25,057 patients with GIB hospitalizations, 22,485 had documented use of at least one target medication class. Mortality after GIB hospitalization p100py was 3.6 (3.3-3.9) at 30 days, 5.7 (5.3-6.1) at 60 days, and 7.1 (6.7-7.6) at 90 days for upper GIB and 3.6 (3.2-4.0) at 30 days, 6.0 (5.5-6.5) at 60 days, and 7.6 (7.0-8.2) at 90 days for lower GIB. Mortality risk varied by medication (figure 1): specifically PPI use was associated with a lower risk for upper GIB but not lower GIB. In contrast, patients on antiplatelets, Warfarin, and DOAC showed mortality rates nearly identical to non-users across all GIB types—suggesting these medications did not significantly alter GIB-related mortality.
Conclusion
In this cohort of dialysis patients, mortality following GIB varied by use of medication with a bleeding risk. and PPI use was associated with decreased mortality after GIB. However, Antiplatelets, DOAC, and Warfarin use were not associated with short-term mortality after GIB, despite its anticoagulant nature. These findings may help inform medication management in dialysis patients.
Funding
- Commercial Support – Fresenius Medical Care