title: Gastrointestinal bleeding in patients with renal failure under hemodialysis treatment: a single-center experience.
abstract: OBJECTIVE
  Gastrointestinal bleeding remains the leading cause of morbidity and mortality for patients who need hemodialysis treatment. Our aim was to evaluate patients who needed hemodialysis and presented with bleeding during their hospital stay (uremic bleeding patients). Factors that increased the risk of bleeding and death were evaluated. Additionally, uremic bleeding patients were compared to non-uremic bleeding patients regarding gastrointestinal findings.
  
  
  METHODS
  Fifty-one uremic bleeding patients were compared to two control groups which included uremic (hemodialysis dependent and non-bleeding) and non-uremic (no renal insufficiency and bleeding) patients.
  
  
  RESULTS
  NSAIDs and anti-ulcer drug usage were more common in uremic bleeding and in uremic non-bleeding groups, respectively. Dialysis vintage was longer in uremic bleeding group. Comparison of uremic bleeding and non-bleeding uremic patients regarding the usage of ACEI or ARB drugs yielded non-significant results. Acute kidney injury, lower plasma albumin level and high CRP level were significantly increased the risk of mortality in uremic bleeding patients. Hospital stay more than 1 week was the only strong factor for mortality when multivariate analysis was performed. Gastroduodenal and duodenal ulcers were significantly detected in uremic bleeding and non-uremic bleeding patients; respectively.
  
  
  CONCLUSIONS
  Hemodialysis patients presenting with gastrointestinal bleeding should be evaluated regarding use of prescriptions and efforts should be done in order to shorten their hospital stay and decrease their mortality. Effect of ACEI or ARB drugs should also be evaluated in future studies.
authors.affiliation: Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, Tıbbiye Cad. No: 40 Üsküdar, 34668, Istanbul, Turkey. canozgur62@hotmail.com.
authors.forename: Özgür
authors.initials: Ö
authors.lastname: Can
authors.affiliation: Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, Tıbbiye Cad. No: 40 Üsküdar, 34668, Istanbul, Turkey.
authors.forename: Gözde
authors.initials: G
authors.lastname: Koç
authors.affiliation: Department of General Surgery, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sema Berk
authors.initials: SB
authors.lastname: Ocak
authors.affiliation: Department of Internal Medicine, Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Nursel
authors.initials: N
authors.lastname: Akbay
authors.affiliation: Department of Gastroenterology, Dr. Kartal Lutfi Kırdar Training and Research Hospital, Istanbul, Turkey.
authors.forename: Emel
authors.initials: E
authors.lastname: Ahishali
authors.affiliation: Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, Tıbbiye Cad. No: 40 Üsküdar, 34668, Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Canbakan
authors.affiliation: Department of Nephrology, Haydarpaşa Numune Training and Research Hospital, Tıbbiye Cad. No: 40 Üsküdar, 34668, Istanbul, Turkey.
authors.forename: Gülizar Manga
authors.initials: GM
authors.lastname: Şahin
authors.affiliation: Department of Nephrology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey.
authors.forename: Süheyla
authors.initials: S
authors.lastname: Apaydin
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002423:Cause of Death; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D014511:Uremia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: Acute kidney injury; Anti-ulcer drugs; Endoscopy; Gastrointestinal bleeding; Hemodialysis; Non-steroidal anti-inflammatory drugs