title: Mesenteric ischemia in patients with end-stage renal disease: a nationwide longitudinal study.
abstract: OBJECTIVE
  Mesenteric ischemia is an uncommon disorder associated with an extremely high mortality rate. Only limited studies have evaluated this lethal disease among patients with end-stage renal disease (ESRD). The objective of this study was to evaluate the risks of mesenteric ischemia among ESRD patients and compare the incidence between two dialysis modalities.
  
  
  METHODS
  Records of all ESRD patients older than 20 years of age from 1998 to 2007 and a control group consisting of 1 million records were retrieved from the Taiwan National Health Insurance Research Database. Hospitalizations for mesenteric ischemic events were retrieved using ICD-9-CM diagnosis codes and ICD-9-CM operation codes from inpatient claims.
  
  
  RESULTS
  Among 55,807 incident ESRD patients who received hemodialysis or peritoneal dialysis, there were 458 mesenteric ischemic events, corresponding to an incidence rate of 2.7 per 1,000 patient-years. Multivariate Cox regression analysis indicated that the independent risk factors were old age (HR 1.42 per 10 years), diabetes (HR 2.85), peripheral vascular disease (HR 2.66), atrial fibrillation (HR 2.15), heart failure (HR 1.65), chronic pulmonary disease (HR 1.41), neoplasm (HR 1.54), peptic ulcer disease (HR 1.86), and peritoneal dialysis (HR 1.51, all p < 0.05). There was no effect of dialysis modality on the mesenteric ischemia mortality rate.
  
  
  CONCLUSIONS
  The risk of mesenteric ischemia for ESRD patients was 44.1 (95% confidence interval 13.4-106.2, p < 0.001) times higher than that of the general population. Compared to hemodialysis, peritoneal dialysis was associated with a higher risk of mesenteric ischemia.
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Szu-Yuan
authors.initials: SY
authors.lastname: Li
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Lung-Wen
authors.initials: LW
authors.lastname: Tsai
authors.forename: Wu-Chang
authors.initials: WC
authors.lastname: Yang
authors.forename: Tzen-Wen
authors.initials: TW
authors.lastname: Chen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D016009:Chi-Square Distribution; D002908:Chronic Disease; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008137:Longitudinal Studies; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D065666:Mesenteric Ischemia; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D010437:Peptic Ulcer / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult