title: Upper gastrointestinal bleeding as a risk factor for dialysis and all-cause mortality: a cohort study of chronic kidney disease patients in Taiwan.
abstract: Impaired renal function is associated with higher risk of upper gastrointestinal bleeding (UGIB) in patients with chronic kidney disease and not on dialysis (CKD-ND). It is unclear if UGIB increases risk of chronic dialysis. The aim of the study was to investigate risk of chronic dialysis in CKD-ND patients with UGIB.
  
  
  
  All CKD-ND stage 3-5 patients of a CKD programme in one hospital between 2003 and 2009 were enrolled and prospectively followed until September 2012.
  
  
  
  Chronic dialysis (dialysis for more than 3 months) started and all-cause mortality. The risk of chronic dialysis was analysed using Cox proportional hazard regression with adjustments for age, gender and renal function, followed by competing-risks analysis.
  
  
  
  We analysed 3126 CKD-ND patients with a mean age of 65±14 years for 2.8 years. Of 3126 patients, 387 (12.4%) patients developed UGIB, 989 (31.6%) patients started chronic dialysis and 197 (6.3%) patients died. UGIB increased all-cause mortality (adjusted HR (aHR): 1.51, 95% CI 1.07 to 2.13) and the risk of chronic dialysis (aHR; 1.29, 95% CI 1.11 to 1.50). The subdistribution HR (SHR) of UGIB for chronic dialysis (competing event: all-cause mortality) was 1.37 (95% CI 1.15 to 1.64) in competing-risks analysis with adjustments for age, renal function, gender, diabetes, haemoglobin, albumin and urine protein/creatinine ratio.
  
  
  
  UGIB is associated with increased risk of chronic dialysis and all-cause mortality in patients with CKD-ND stages 3-5. This association is independent of age, gender, basal renal function, haemoglobin, albumin and urine protein levels.
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan Graduate Program of Translational Medicine, China Medical University, Taichung, Taiwan Institute of Biomedical Sciences, Academia Sinica, Taipei, 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 College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Che-Yi
authors.identifier: 0000-0003-4029-9097
authors.initials: CY
authors.lastname: Chou
authors.affiliation: Kidney Institute and Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan 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 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 College of Medicine, China Medical University, Taichung, Taiwan Graduate Program of Translational Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006396:Hematemesis / Q000453:epidemiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008551:Melena / Q000453:epidemiology*; D008875:Middle Aged; D009026:Mortality; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D013624:Taiwan / Q000453:epidemiology
chemical_list: D012709:Serum Albumin