Patients with advanced chronic kidney disease (CKD) face a significantly higher risk of potentially fatal gastrointestinal bleeding, according to a retrospective study presented at the National Kidney Foundation (NKF) Spring Clinical meeting. Individuals with stage 5 CKD had a 40% higher chance of hospitalization due to gastrointestinal bleeding compared to those without CKD. Furthermore, these patients had higher rates of all-cause mortality when hospitalized with gastrointestinal bleeding. Patients with stage 5 CKD who were not on dialysis had a 2.3 times higher risk of mortality, while those on dialysis had a 1.9 times higher risk. These findings highlight the importance of addressing the impact of advanced CKD on patient outcomes.
Impact of Endoscopic Evaluations
Dr. Mingyue He, the lead researcher of the study, noted that patients with end-stage kidney disease (ESKD) were less likely to undergo early endoscopic evaluations, which could contribute to higher mortality rates. Despite comparable endoscopy rates among patients hospitalized with gastrointestinal bleeding, individuals with stage 5 CKD experienced fewer early endoscopies and more delayed procedures. The study found that patients with stage 5 CKD who underwent delayed endoscopies had a 60% higher chance of mortality. Understanding the timing and impact of endoscopic evaluations is crucial for improving patient outcomes in this population.
While international consensus guidelines recommend that endoscopy should occur within 24 hours of presentation for patients with acute upper GI bleeding, this may not always be the case in clinical practice. Various factors such as previous procedures, electrolyte imbalances, dialysis schedules, and thrombocytopenia can influence the decision-making process regarding endoscopy timing. Additionally, anesthesia complications in patients with advanced CKD and ESKD may contribute to delays in the procedure. Addressing these challenges and understanding the reasons behind delayed endoscopic evaluations is essential for improving adherence to guidelines and enhancing patient outcomes.
Patients with advanced CKD on dialysis had higher rates of interventions such as angiograms, ventilation, vasopressor use, blood transfusion, and prolonged hospitalizations compared to those without CKD. They also experienced more gastrointestinal bleeding caused by ulcers or unspecified sources. Stage 5 CKD patients, regardless of dialysis status, had a higher risk of GI bleeding associated with angiodysplasia. On the other hand, kidney transplant recipients had an increased risk of diverticular bleeding. The study also noted a significant decrease in the incidence of angiodysplasia post-kidney transplant, suggesting a link to uremic-related factors contributing to bleeding.
While the study provided valuable insights into the association between advanced CKD and gastrointestinal bleeding, there are limitations that warrant further investigation. Future research should explore the reasons behind delayed endoscopic evaluations in ESKD patients and how these factors impact patient outcomes. By addressing these challenges and improving adherence to guidelines, healthcare providers can enhance the care and management of patients with advanced CKD. The study’s findings underscore the importance of early interventions and comprehensive care for individuals with CKD to reduce the risk of gastrointestinal bleeding and improve overall outcomes.
Leave a Reply