Journal Mobile Options
Table of Contents
Vol. 35, No. 3, 2012
Issue release date: March 2012
Am J Nephrol 2012;35:216–224

Chronic Kidney Disease and End-Stage Renal Disease Predict Higher Risk of Mortality in Patients with Primary Upper Gastrointestinal Bleeding

Sood P. · Kumar G. · Nanchal R. · Sakhuja A. · Ahmad S. · Ali M. · Kumar N. · Ross E.A.
Divisions of aNephrology and bPulmonary and Critical Care, and cDepartment of Medicine, Medical College of Wisconsin, Milwaukee, Wisc., dDepartment of Nephrology and Hypertension, Cleveland Clinic Foundation, Cleveland, Ohio, and eDivision of Nephrology, Hypertension and Renal Transplantation, University of Florida, Gainesville, Fla., USA

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: The outcome of gastrointestinal bleeding in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients is difficult to discern from the literature. Many publications are small, single-center series or are from an era prior to advanced interventional endoscopy, widespread use of proton pump inhibitors or treatment for Helicobacter pylori infections. In this study, we quantify the role of CKD and ESRD as independent predictors of mortality in patients admitted to the hospital with a principal diagnosis of primary upper gastrointestinal bleeding (UGIB). Methods: We used the Nationwide Inpatient Sample that contains data on approximately 8 million admissions in 1,000 hospitals chosen to approximate a 20% stratified sample of all US facilities. Patients discharged with the principal diagnosis of primary UGIB, CKD or ESRD were identified through the ninth revision of the International Classification of Diseases, clinical modification (ICD-9-CM) codes. The outcome variables included frequency and in-hospital mortality of UGIB in CKD and ESRD patients as compared to non-CKD patients and were analyzed using logistic regression modeling. Results: In 2007, out of a total of 398,213 admissions with a diagnosis of primary UGIB, 35,985 were in CKD, 14,983 in ESRD, and 347,245 in non-renal disease groups. The OR for primary UGIB hospitalization in CKD and ESRD was 1.30 (95% CI 1.17–1.46) and 1.84 (95% CI 1.61–2.09), respectively. The corresponding all-cause mortality OR was 1.47 (95% CI 1.21–1.78) and 3.02 (95% CI 2.23–4.1), respectively. Conclusion: Patients with CKD or ESRD admitted with primary UGIB have up to three times higher risk of all-cause in-hospital mortality, warranting heightened vigilance by their clinicians.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Kang JY: The gastrointestinal tract in uremia. Dig Dis Sci 1993;38:257–268.
  2. Chalasani N, Cotsonis G, Wilcox CM: Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol 1996;91:2329–2332.
  3. Cheung J, Yu A, LaBossiere J, Zhu Q, Fedorak RN: Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease. Gastrointest Endosc 2010;71:44–49.
  4. Toke AB: GI bleeding risk in patients undergoing dialysis. Gastrointest Endosc 2010;71:50–52.
  5. Holden RM, Harman GJ, Wang M, Holland D, Day AG: Major bleeding in hemodialysis patients. Clin J Am Soc Nephrol 2008;3:105–110.
  6. Wasse H, Gillen DL, Ball AM, et al: Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int 2003;64:1455–1461.
  7. Galbusera M, Remuzzi G, Boccardo P: Treatment of bleeding in dialysis patients. Semin Dial 2009;22:279–286.
  8. Sohal AS, Gangji AS, Crowther MA, Treleaven D: Uremic bleeding: pathophysiology and clinical risk factors. Thromb Res 2006;118:417–422.
  9. Boyle JM, Johnston B: Acute upper gastrointestinal hemorrhage in patients with chronic renal disease. Am J Med 1983;75:409–412.
  10. Zuckerman GR, Cornette GL, Clouse RE, Harter HR: Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 1985;102:588–592.
  11. Tsai CJ, Hwang JC: Investigation of upper gastrointestinal hemorrhage in chronic renal failure. J Clin Gastroenterol 1996;22:2–5.
  12. Fiaccadori E, Maggiore U, Clima B, Melfa L, Rotelli C, Borghetti A: Incidence, risk factors, and prognosis of gastrointestinal hemorrhage complicating acute renal failure. Kidney Int 2001;59:1510–1519.
  13. Chen YC, Tsai MH, Hsu CW, et al: Role of serum creatinine and prognostic scoring systems in assessing hospital mortality in critically ill cirrhotic patients with upper gastrointestinal bleeding. J Nephrol 2003;16:558–565.
  14. Klebl F, Bregenzer N, Schöfer L, et al: Risk factors for mortality in severe upper gastrointestinal bleeding. Int J Colorectal Dis 2005;20:49–56.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50