title: Risk factors of short-term mortality after acute nonvariceal upper gastrointestinal bleeding in patients on dialysis: a population-based study.
abstract: BACKGROUND
  Impaired kidney function is an established predictor of mortality after acute nonvariceal upper gastrointestinal bleeding (ANVUGIB); however, which factors are associated with mortality after ANVUGIB among patients undergoing dialysis is unknown. We examined the associations among demographic characteristics, dialysis-specific features, and comorbid conditions with short-term mortality after ANVUGIB among patients on dialysis.
  
  
  METHODS
  
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  United States Renal Data System (USRDS), a nation-wide registry of patients with end-stage renal disease.
  
  
  METHODS
  All ANVUGIB episodes identified by validated algorithms in Medicare-covered patients between 2003 and 2007.
  
  
  METHODS
  Demographic characteristics and comorbid conditions from 1 year of billing claims prior to each bleeding event. We used logistic regression extended with generalized estimating equations methods to model the associations among risk factors and 30-day mortality following ANVUGIB events.
  
  
  RESULTS
  From 2003 to 2007, we identified 40,016 eligible patients with 50,497 episodes of ANVUGIB. Overall 30-day mortality was 10.7% (95% CI: 10.4-11.0). Older age, white race, longer dialysis vintage, peritoneal dialysis (vs. hemodialysis), and hospitalized (vs. outpatient) episodes were independently associated with a higher risk of 30-day mortality. Most but not all comorbid conditions were associated with death after ANVUGIB. The joint ability of all factors captured to discriminate mortality was modest (c=0.68).
  
  
  CONCLUSIONS
  We identified a profile of risk factors for 30-day mortality after ANVUGIB among patients on dialysis that was distinct from what had been reported in non-dialysis populations. Specifically, peritoneal dialysis and more years since initiation of dialysis were independently associated with short-term death after ANVUGIB.
authors.affiliation: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 1070 Arastradero Rd,, Suite 313, Palo Alto, CA 94304, 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: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult