Gastrointestinal Bleeding in CKD Stage 5, Kidney Transplant Patients

Mingyue He and other researchers studied the prevalence, etiology, interventions, and outcomes of gastrointestinal bleeding (GIB) in patients with stage 5 chronic kidney disease not on dialysis (CKD5ND), stage 5 CKD on dialysis (CKD5D), and patients who had kidney transplant (KT) versus a kidney-disease-free group (KDF). They presented results during the National Kidney Foundation Spring Clinical Meetings.

The population-based analysis included 527,640 adults with GIB from the 2019 National Inpatient Sample database. Incidence of GIB was much greater in the CKD5D group (adjusted odds ratio [aOR], 1.4; 95% CI, 1.3-1.4; P<.001) versus the others. When compared with the KDF group, patients in the CKD5ND group experienced the highest adjusted inpatient mortality (aOR, 2.3; 95% CI, 1.4-3.9; P=.001); the next highest was the CKD5D group (aOR, 1.9; 95% CI, 1.6-2.3; P<.001). Patients in the KT group had adjusted mortality comparable with the KDF group (P=.7).

The CKD5D group had endoscopy rates similar to those of KDF patients but had fewer early endoscopies (<24 hours) and more delayed endoscopies (>48 hours). CKD5D patients also had higher rates of angiograms, ventilation, vasopressor use, blood transfusion, and lengthy, expensive hospitalizations versus those in the KDF group (P<.05 for all).

Late endoscopy among CKD5D patients was associated with higher mortality rates (aOR, 1.6; 95% CI, 1.2-2.1; P=.001). Angiodysplasia was associated with increased GIB risk in CKD5ND and CKD5D patients (P<.001). The CKD5D group had more GIB attributed to ulcers and unspecified causes (P<.001), while the KT group had an increased risk of diverticular bleeding (P<.001).

Overall, despite comparable endoscopy rates, CKD5D patients had higher GIB prevalence, mortality, morbidity, and resource use. The researchers noted that further research is needed to identify barriers to endoscopy in these patients.

Source: He M, Desai S, Wang Y, Gillespie A, Friedenberg F. Gastrointestinal bleeding (GIB) in advanced chronic kidney disease and kidney transplant (KT) recipients: a national analysis. Presented at the National Kidney Foundation Spring Clinical Meetings 2024; May 14-18, 2024; Long Beach, California.