Peptic ulcer disease risk in chronic kidney disease: ten-year incidence, ulcer location, and ulcerogenic effect of medications.
OBJECTIVE
We aimed at determining peptic ulcer disease (PUD) incidence among chronic kidney disease (CKD) patients during 1998-2008, compared to patients without CKD, and at examining associations between CKD and PUD.


METHODS
Data for 1998-2008 were extracted from the National Health Insurance Research Database in Taiwan. The annual PUD incidence (cases per thousand persons per year) was calculated separately for patients with and without CKD. Characteristics of patients with newly diagnosed PUD (n = 16322) were compared to those of a control group without PUD (n = 32644). The 2 groups were matched for age, sex, and index year. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by logistic regression.


RESULTS
Over the 10-year period, the PUD incidence was ∼10-12 times higher in CKD patients than in those without CKD. Its incidence in elderly CKD patients increased rapidly over time. For CKD patients, most PUD events (>95%) were managed during hospitalization. Peptic ulcer risk, adjusted for all potential confounders, was much higher in CKD patients undergoing hemodialysis (adjusted OR, 9.74; 95% CI, 7.11-13.31). Maintenance hemodialysis patients were 2 times more likely to have gastric ulcers than duodenal ulcers, while CKD patients not on dialysis had similar risks for both. There were no significant interactions between medications and CKD status on the peptic ulcer risk. Unlike CKD patients on nonsteroidal anti-inflammatory drugs and clopidogrel, those on aspirin did not have a higher peptic ulcer risk (adjusted OR, 0.88; 95% CI, 0.44-1.77).


CONCLUSIONS
CKD patients have a substantially increased PUD risk, and the majority of CKD patients with PUD require hospital management. Further, peptic ulcer risk is affected by hemodialysis therapy, patient status (inpatient vs. outpatient), and ulcerogenic medications.
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Chih-Chia
CC
Liang
Department of Public Health, China Medical University, Taichung, Taiwan ; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Chih-Hsin
CH
Muo
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
I-Kuan
IK
Wang
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Chiz-Tzung
CT
Chang
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Che-Yi
CY
Chou
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Jiung-Hsiun
JH
Liu
Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan ; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Tzung-Hai
TH
Yen
Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan ; Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Chiu-Ching
CC
Huang
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan ; Department of Health Risk Management, College of Public Health, China Medical University, Taichung, Taiwan.
Chi-Jung
CJ
Chung
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D004381:Duodenal Ulcer / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced / Q000453:epidemiology*; D011379:Prognosis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000628:therapy; D012307:Risk Factors; D013276:Stomach Ulcer / Q000139:chemically induced / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
D000894:Anti-Inflammatory Agents, Non-Steroidal