Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan.
BMJ Open
; 6(5): e010439, 2016 05 05.
Article
en En
| MEDLINE
| ID: mdl-27150184
ABSTRACT
OBJECTIVE:
Impaired renal function is associated with higher risk of upper gastrointestinal bleeding (UGIB) in patients with chronic kidney disease and not on dialysis (CKD-ND). It is unclear if UGIB increases risk of chronic dialysis. The aim of the study was to investigate risk of chronic dialysis in CKD-ND patients with UGIB.SETTING:
All CKD-ND stage 3-5 patients of a CKD programme in one hospital between 2003 and 2009 were enrolled and prospectively followed until September 2012. PRIMARY AND SECONDARY OUTCOMEMEASURES:
Chronic dialysis (dialysis for more than 3â months) started and all-cause mortality. The risk of chronic dialysis was analysed using Cox proportional hazard regression with adjustments for age, gender and renal function, followed by competing-risks analysis.RESULTS:
We analysed 3126 CKD-ND patients with a mean age of 65±14â years for 2.8â years. Of 3126 patients, 387 (12.4%) patients developed UGIB, 989 (31.6%) patients started chronic dialysis and 197 (6.3%) patients died. UGIB increased all-cause mortality (adjusted HR (aHR) 1.51, 95% CI 1.07 to 2.13) and the risk of chronic dialysis (aHR; 1.29, 95% CI 1.11 to 1.50). The subdistribution HR (SHR) of UGIB for chronic dialysis (competing event all-cause mortality) was 1.37 (95% CI 1.15 to 1.64) in competing-risks analysis with adjustments for age, renal function, gender, diabetes, haemoglobin, albumin and urine protein/creatinine ratio.CONCLUSIONS:
UGIB is associated with increased risk of chronic dialysis and all-cause mortality in patients with CKD-ND stages 3-5. This association is independent of age, gender, basal renal function, haemoglobin, albumin and urine protein levels.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Hematemesis
/
Melena
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Diálisis Renal
/
Fallo Renal Crónico
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Región como asunto:
Asia
Idioma:
En
Revista:
BMJ Open
Año:
2016
Tipo del documento:
Article