title: Early eradication has a lower risk of peptic ulcer bleeding in Helicobacter pylori-infected chronic kidney disease patients.
abstract: BACKGROUND
  End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori (H. pylori) eradication therapy is necessary for H. pylori-infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage.
  
  
  METHODS
  Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB.
  
  
  RESULTS
  We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB.
  
  
  CONCLUSIONS
  Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori-infected CKD patients.
authors.affiliation: Division of Allergy, Immunology, Rheumatology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan.
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan.
authors.forename: Hsiao-Yun
authors.initials: HY
authors.lastname: Hu
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan; School of Medicine, National Yang-Ming University, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan. Electronic address: DAH20@tpech.gov.tw.
authors.forename: Shen-Shong
authors.initials: SS
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000453:epidemiology*; D010438:Peptic Ulcer Hemorrhage / Q000453:epidemiology*; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013624:Taiwan; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Chronic kidney disease; End stage renal disease; Eradication; Helicobacter pylori; Peptic ulcer bleeding