Upper Gastrointestinal Bleeding in Patients with CKD

作者：Liang Chih Chia; Wang Su Ming; Kuo Huey Liang; Chang Chiz Tzung; Liu Jiung Hsiun; Lin Hsin Hung; Wang I Kuan; Yang Ya Fei; Lu Yueh Ju; Chou Che Yi^*; Huang Chiu Ching

来源：Clinical Journal of the American Society of Nephrology, 2014, 9(8): 1354-1359.

DOI：10.2215/CJN.09260913

Background and objectives Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. %26lt;br%26gt;Design, setting, participants, %26 measurements Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. %26lt;br%26gt;Results In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stages CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93(95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (P%26lt;0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk. %26lt;br%26gt;Conclusions In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.

• 出版日期2014-8
• 单位中国医科大学