title: Proton-pump inhibitors for prevention of upper gastrointestinal bleeding in patients undergoing dialysis.
abstract: OBJECTIVE
  To investigate the preventive effects of low-dose proton-pump inhibitors (PPIs) for upper gastrointestinal bleeding (UGIB) in end-stage renal disease.
  
  
  METHODS
  This was a retrospective cohort study that reviewed 544 patients with end-stage renal disease who started dialysis at our center between 2005 and 2013. We examined the incidence of UGIB in 175 patients treated with low-dose PPIs and 369 patients not treated with PPIs (control group).
  
  
  RESULTS
  During the study period, 41 patients developed UGIB, a rate of 14.4/1000 person-years. The mean time between the start of dialysis and UGIB events was 26.3 ± 29.6 mo. Bleeding occurred in only two patients in the PPI group (2.5/1000 person-years) and in 39 patients in the control group (19.2/1000 person-years). Kaplan-Meier analysis of cumulative non-bleeding survival showed that the probability of UGIB was significantly lower in the PPI group than in the control group (log-rank test, P < 0.001). Univariate analysis showed that coronary artery disease, PPI use, anti-coagulation, and anti-platelet therapy were associated with UGIB. After adjustments for the potential factors influencing risk of UGIB, PPI use was shown to be significantly beneficial in reducing UGIB compared to the control group (HR = 13.7, 95%CI: 1.8-101.6; P = 0.011).
  
  
  CONCLUSIONS
  The use of low-dose PPIs in patients with end-stage renal disease is associated with a low frequency of UGIB.
authors.affiliation: Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
authors.forename: Young Rim
authors.initials: YR
authors.lastname: Song
authors.affiliation: Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
authors.forename: Hyung Jik
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
authors.forename: Jwa-Kyung
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
authors.forename: Sung Gyun
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Young Rim Song, Hyung Jik Kim, Jwa-Kyung Kim, Sung Gyun Kim, Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Kidney Research Institute, Hallym University College of Medicine, Anyang-si 431-070, South Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors
keywords: Dialysis; End-stage renal disease; Gastrointestinal hemorrhage; Peptic ulcer; Proton pump inhibitors