title: Nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients.
abstract: OBJECTIVE
  Hemodialysis patients carry a higher risk of peptic ulcer bleeding. Whether hemodialysis patients also have a higher occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding needs further evaluation.
  
  
  METHODS
  Using Taiwan's National Health Insurance research database, the occurrence of nonpeptic ulcer, nonvariceal gastrointestinal bleeding was compared among the hemodialysis patients, chronic kidney disease patients, and controls using log-rank test. Risk factors were identified by Cox regression analysis.
  
  
  RESULTS
  A total of 20,830 patients were enrolled, including 8210 hemodialysis and 4190 chronic kidney disease patients and 8430 age- and sex-matched controls in a 2:1:2 ratio. In the 7-year follow-up period, hemodialysis patients had a significantly higher cumulative hazard of nonpeptic ulcer, nonvariceal gastrointestinal bleeding than chronic kidney disease patients and controls (P <.001, by log-rank test). The hazard also was significantly higher in the chronic kidney disease patients than in controls. Cox regression analysis revealed that older age, the comorbidities of diabetes mellitus, cirrhosis, and chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, chronic kidney disease (hazard ratio 5.17), hemodialysis (hazard ratio 9.43), and use of selective serotonin reuptake inhibitors were independent risk factors for nonpeptic ulcer, nonvariceal gastrointestinal bleeding in all study patients. Old age, diabetes mellitus, cirrhosis, chronic obstructive pulmonary disease, history of uncomplicated peptic ulcer disease, and use of selective serotonin reuptake inhibitors were independent risk factors in hemodialysis patients.
  
  
  CONCLUSIONS
  There is a higher risk of developing nonpeptic ulcer, nonvariceal gastrointestinal bleeding in hemodialysis patients after adjustments for age, sex, underlying comorbidities, and ulcerogenic medication. The risk has increased since patients had chronic kidney disease.
authors: Department of Medicine, National Yang-Ming University, School of Medicine, Taipei City, Taiwan. jcluo@vghtpe.gov.tw
authors: Jiing-Chyuan
authors: JC
authors: Luo
authors: Hsin-Bang
authors: HB
authors: Leu
authors: Ming-Chih
authors: MC
authors: Hou
authors: Kuang-Wei
authors: KW
authors: Huang
authors: Han-Chieh
authors: HC
authors: Lin
authors: Fa-Yauh
authors: FY
authors: Lee
authors: Wan-Leong
authors: WL
authors: Chan
authors: Shing-Jong
authors: SJ
authors: Lin
authors: Jaw-Wen
authors: JW
authors: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012307:Risk Factors; D012737:Sex Factors