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PEPTIC ULCER BLEEDING OUTCOME IS ADVERSELY AFFECTED IN PATIENTS WITH END-STAGE RENAL DISEASE: A CASE CONTROL STUDY

J Cheung, A Yu, J LaBossiere , R Fedorak
University of Alberta, Edmonton, Alberta

BACKGROUND: Patients with chronic renal failure (CRF) are at higher risk of bleeding complications as a result of platelet and coagulation dysfunction. Non-variceal peptic ulcer disease (PUD) bleeding outcomes have not recently been evaluated in patients with CRF.
OBJECTIVES: Using case-controlled methodology, we examined PUD bleeding clinical outcomes in patients with CRF.
METHODS: Medical records of patients presenting with PUD bleeding and CRF (based on ICD 9 codes) between January 2001 and 2006 were reviewed; Group 1, end-stage renal disease (ESRD), (criteria: hemodialysis or peritoneal dialysis) and Group 2, non-ESRD (age-matched to ESRD, criteria, Cr>100 for >3 months). Results were compared to an age-matched control population with normal renal function (Cr<100). All PUD bleeding patients were treated with proton pump inhibitors on presentation and underwent endoscopy.
RESULTS: 63 patients with PUD bleeding (21 ESRD, 21 non-ESRD, 21 controls) were compared. No differences in baseline characteristics (age, Rockall score, and proportion of ulcers with high risk stigmata) existed between the groups. The re-bleeding rate in patients with ESRD (47.6%) was significantly higher relative to patients with non-ESRD CRF (9.5%, p<0.01) or controls (14.3%, p<0.05). Transfusion requirements post-endoscopy (3 units vs 1.6 units) and length of hospital stay (46d vs 20d) were significantly higher in the ESRD when compared to the normal control group (p<0.05). The 30d mortality (14.3%) was significantly higher in the ESRD group compared with the non-ESRD group (4.8%, p<0.01) and control group (0%, p<0.05).
CONCLUSION: Patients with ESRD have significantly higher re-bleeding rates, transfusion requirements, length of stay and mortality rates compared to patients with normal renal function, despite optimal hemostatic PUD bleeding management. There does not appear to be any increase in adverse outcomes in patients with non-ESRD CRF.

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