CLINICAL PROFILE, ENDOSCOPY AND COLONOSCOPY FINDINGS AS WELL AS PROTON PUMP INHIBITOR USE AMONG FILIPINO CHRONIC KIDNEY DISEASE PATIENTS WITH GASTROINTESTINAL BLEEDING IN NAGA CITY, PHILIPPINES

The global prevalence of Chronic Kidney Disease (CKD) is estimated to be at 843.6 million. In the Philippines, the National Kidney and Transplant Institute (NKTI) has reported that one Filipino develops chronic renal failure every hour or about 120 Filipinos per million population every year. Among its many complications, CKD is identified as an independent risk factor for gastrointestinal bleeding (GIB). The risk of GIB in CKD patients increases as the hemostatic disturbances may be induced by the underlying renal disease.

This case-control study was conducted among CKD patients stages 3 to 5 who were admitted in a tertiary private hospital in Naga City, Philippines from January 2018 to December 2023. Data was collected via a retrospective review of medical charts to determine the clinical profile, management and outcomes of the subjects. Data was encoded in MS Excel by the researcher. IBM SPSS software was used for data processing and analysis. Chi Square test was used to assess the significant association between variables. 

A total of 159 patients were included in the study, with 55 cases of either upper or lower GIB were matched to 104 controls. A total of 159 patients were collected during the data collection period, of which 69 were females, 90 were males. Age ranged from 27 years to 100 years. Most of the patients (43%) required multiple blood transfusions to increase hemoglobin levels. The most common endoscopic finding was gastric erosions (18%) followed by gastritis (10%) while the most frequent colonoscopy finding was colonic polyps (3%). The use of proton pump inhibitors (PPIs) was significantly associated with a reduction in GIB. In this subset of patients, 13% of the total population expired during the course of their admission. Most patients also had a length of stay varying between 5-15 days, with 46% staying between the range of 6-10 days, 31% for less than 5 days, and 12% for 11-15 days. Furthermore, 6% had significant morbidity, of which 5 had Myocardial Infarction, 2 had Pneumonia, 1 had Congestive Heart Failure and 1 had Cerebrovascular disease. The study found a weak positive correlation between cardiac conditions and GIB (Cramer’s V = 0.186), with a p-value of 0.019. Medication use, specifically NSAIDs and steroids, was identified as a significant factor associated with GIB. Hemodialysis as a modality in itself also increased the risk of GIB. Abdominal pain and vomiting were two symptoms significantly associated with GIB, with abdominal pain showing a notable correlation (Cramer’s V = 0.497, p < 0.001) and vomiting showing a weaker but significant correlation (Cramer’s V = 0.221, p = 0.005). Similarly, CKD stage was weakly correlated with the duration of PPI use (Cramer’s V = 0.116, p = 0.641) and the type of PPI used (Cramer’s V = 0.194, p = 0.063).

The study findings emphasize that GIB among CKD patients is influenced by various clinical factors, which correlate with patient outcomes. The use of PPIs and blood transfusion were particularly highlighted as crucial interventions that could mitigate bleeding. These results underscore the importance of proactive management strategies, early detection, and appropriate therapeutic interventions to reduce the incidence and severity of GIB among CKD patients. Continuous assessment of the complications of GIB and tailored patient care are vital for improving outcomes and enhancing the quality of life for CKD patients in the Philippines.