title: The three-year incidence of major hemorrhage among older adults initiating chronic dialysis.
abstract: BACKGROUND
  For those who initiate chronic dialysis, knowing what proportion will experience 3-year outcomes of hemorrhage with hospitalization informs patient prognosis, disease impact, and the planning of trials and programs to prevent events.
  
  
  OBJECTIVE
  We examined the incidence of hemorrhage and related gastrointestinal endoscopic procedures in incident older dialysis patients and stratified patients by age, era, dialysis modality and whether recently prescribed anti-thrombotic medication.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Ontario, Canada from 1998 to 2008 (n = 11,173).
  
  
  METHODS
  All older patients (>65 years) who initiated chronic dialysis.
  
  
  METHODS
  Hospitalization with hemorrhage and its subtypes (upper and lower gastrointestinal, intra-cerebral, subarachnoid) and related-gastrointestinal procedures.
  
  
  METHODS
  Three-year outcomes of hospitalization with hemorrhage were expressed as cumulative incidence and incidence rate (number of events per 1,000 patient years). Results were stratified by patient age (66 to 74, 75 to 84, ≥ 85), era (1998 to 2001, 2002 to 2005, 2006 to 2008) and dialysis modality. Among those with hemorrhage, we examined prescriptions for anti-thrombotic medications (warfarin, clopidogrel) in the preceding 120 days.
  
  
  RESULTS
  The 3-year cumulative incidence of hemorrhage was 14.4% (roughly 1 in 7 patients). By location, the 3-year cumulative incidence was 8.9% lower gastrointestinal, 6.1% upper gastrointestinal, 0.9% intra-cerebral and 0.1% sub arachnoid hemorrhage. The 3-year cumulative incidence of gastrointestinal endoscopic procedures was 14.8%. The cumulative incidence and rate of hemorrhage were not appreciably different across the 3 age strata, by era or by dialysis modality. Among patients with a hemorrhage, 29.5% were prescribed warfarin in the preceding 120 days, and 8.4% clopidogrel.
  
  
  CONCLUSIONS
  Recurrent events were not included.
  
  
  CONCLUSIONS
  Many older patients who initiate chronic dialysis will be hospitalized with hemorrhage and receive related procedures over the subsequent three years. Despite greater age and co-morbidity over the last decade this incidence has not changed.
authors.affiliation: Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa Institute for Clinical Evaluative Sciences, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, Box 693, Ottawa, ON Canada.
authors.forename: Manish M
authors.initials: MM
authors.lastname: Sood
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON Canada ; Department of Epidemiology and Biostatistics, Western University, London, ON Canada.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Bota
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: McArthur
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON Canada ; Department of Medicine, University of Toronto, Toronto, ON Canada ; The Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON Canada.
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.affiliation: Seven Oaks General Hospital, Winnipeg, MB, Ontario Canada.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Tangri
authors.affiliation: Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa Institute for Clinical Evaluative Sciences, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, Box 693, Ottawa, ON Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Knoll
authors.affiliation: Ottawa Hospital Research Institute, Department of Medicine, University of Ottawa, Ottawa Institute for Clinical Evaluative Sciences, Civic campus, 2-014 Administrative Services Building, 1053 Carling Avenue, Box 693, Ottawa, ON Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Zimmerman
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, ON Canada ; Department of Epidemiology and Biostatistics, Western University, London, ON Canada ; Kidney Clinical Research Unit, Division of Nephrology, Western University, London, ON Canada ; Division of Nephrology, Department of Medicine, Western University, London, ON Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg