title: Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005).
abstract: BACKGROUND
  Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients.
  
  
  METHODS
  We studied all dialysis patients (1992-2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999.
  
  
  RESULTS
  Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time.
  
  
  CONCLUSIONS
  In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, USA.
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.forename: Tsung-Chun
authors.initials: TC
authors.lastname: Lee
authors.forename: Maria E
authors.initials: ME
authors.lastname: Montez-Rath
authors.forename: Manisha
authors.initials: M
authors.lastname: Desai
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000328:Adult; D000368:Aged; D002614:Chelating Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007416:Intestinal Perforation / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011073:Polyamines / Q000009:adverse effects; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D000069603:Sevelamer; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D002614:Chelating Agents; D011073:Polyamines; D000069603:Sevelamer