title: Upper gastrointestinal bleeding in patients with CKD.
abstract: OBJECTIVE
  Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed.
  
  
  METHODS
  Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates.
  
  
  RESULTS
  In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (P<0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk.
  
  
  CONCLUSIONS
  In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin.
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Su-Ming
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Huey-Liang
authors.initials: HL
authors.lastname: Kuo
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Hsin-Hung
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Ya-Fei
authors.initials: YF
authors.lastname: Yang
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and.
authors.forename: Yueh-Ju
authors.initials: YJ
authors.lastname: Lu
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan cychou.chou@gmail.com.
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; and College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology*; D005919:Glomerular Filtration Rate; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000453:epidemiology; D015994:Incidence; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D000075462:Serum Albumin, Human; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
chemical_list: C422455:ALB protein, human; D015415:Biomarkers; D012709:Serum Albumin; D000075462:Serum Albumin, Human
keywords: CKD; GFR; gastrointestinal complications