UPPER GASTROINTESTINAL BLEEDING IN END-STAGE CHRONIC KIDNEY DISEASE

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-3023, Poster Board= FRI-123

Introduction:

Upper Gastrointestinal Bleeding (UGIB) is a common cause of hospital admission in patients with End-Stage Chronic Kidney Disease (ESKD). The presence of multiple comorbidities and a uremic microenvironment increases the risk of complications and mortality in these patients. Despite its prevalence, there is limited information on the predisposing factors and predictive scores for adverse outcomes in this population.

Methods:

Retrospective clinical study at Hospital Civil de Guadalajara, Mexico, from july 21 until April 24, all patients with ESRD admitted to the Nephrology service with UGIB. We analyzed the comorbidities, symptoms, endoscopic finding and evolution during their hospitalization and compared them with HTDA and ESRD prevalent.We performed a statical analysis in SPSS, including frequencies, percentages, mean (SD), median (IQR), Studen´s T test, chi square, fisher or Mann Whitney U to compare between groups

Results:

We analyzed 180 patients, 65% were male, with a mean age of 46 years. Fifty-three percent of the patients does not have previously dialysis therapy. 

Only 52% of the patient had diagnosed endoscopy during their hospitalization, the rest were discharged with PPI after the resolution of symptoms and having received dialysis, while awaiting outpatient endoscopy. See table 1-3

Table 1. Global Charateristics

N = 180

Male (%)

117 (65)

Age (y)

46.6±16

ESKD (without dialysis)

95 (53)

SBP

114±29

DBP

70±19

MAP

83±19

Hemoglobin

7.74±2.9

Hematocrit

24.5±8.6

Platelets

206±107

Glucose

114±63

Serum Creatinine

10.9±7.2

Urea

204.2±124

Serum albumin

2.99±0.7

PT

15.4±1.7

aPTT

29.8±7.6

Sodium

135±5

Potassium

5.0±1.1

Calcium

7.9±1.3

Hospital (days)

10.24±8.7

Transfusions (RBC)

2.74±1.8

Dead

45 (25)

 

Table 2. Clinical and laboratory findings

No Endoscopy (n=86)

Endoscopy (n=94)

p-value

Glasgow-Blatchford ³3

86 (100)

93 (98.9)

0.522

Rockall score³5

20 (23.3)

25 (26.6)

0.366

AIMS65 ³2

30 (34.9)

38 (40.4)

0.270

High-Risk ABC

44 (51.8)

64 (68.1)

0.019

SCr

12.4 ± 8.3

9.6 ± 5.9

0.009

Urea

230.6 ± 143.7

181.2 ± 101.3

0.005

Rebleeding

1 (1.2)

9 (9.7)

0.013

Hospital stay (days)

8.9±7.8   

11.4±9.4

0.064

PPI infusion

50 (58.1)

80 (85.1)

<0.001

Transfusión

53 (63.1)

53 ( 56.4)

0.224

RBC transfusion

2.3±1.2  

3.14±2.1   

0.008

Death

26 (30.2)

19 (20.2)

0.084

Causes of death:

Associated with ESKD

Associated with UGIB

Sepsis

 

5 (21.7)

10 (43.5)

8 (34.8)

 

8 (42.1)

4 (21.1)

6 (31.6)

 

 

 

0.240

Hemodialysis

46 (54.1)

54 (57.4)

0.383

Peritoneal Dialysis

33 (38.8)

37 (39.4)

0.532

 

Table 3. Endoscopic finding

 

Ulcers

56

Erosive esophagitis

61

Variceal plexus

5

Angiodysplasias

2

Dieulafoy´s Disease

1

Mallory-Weiss

2

Vater´s ampulla bleeding

1

Visceral perforation

2

Bulboduodenitis

35

Endoscopic treatment

15 (8.6)

Conclusions:

Endoscopic findings most common were ulcers and erosive esophagitis, angiodysplasia was a rare finding. Patients with higher Urea and SCr were managed with dialysis and endoscopy was delayed, this could be because the bleeding was attributed to uremic syndrome and treatment focused on resolving uremia before performing endoscopy. UGIB was part of the symptoms attributed to uremic syndrome in more than 50% of the patients. 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.