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PTH-002 Gastrointestinal Bleeding in Dialysis Patients: Identifying Incidence, Risk Factors and Endoscopy Findings
  1. A Kumar1,
  2. B Bachi2,
  3. H Razaq2,
  4. ED Justice3,
  5. A Yew4,
  6. K Shivakumar5
  1. 1Cardiology, New Cross Hospital, Wolverhampton
  2. 2Vascular Surgery, Russells Hall Hospital
  3. 3High Dependence Unit, New Cross Hospital, Dudley, Birmingham
  4. 4Geriatrics, New Cross Hospital, Wolverhampton
  5. 5Nephrology, Russells Hall Hospital, Dudley, Birmingham, UK

Abstract

Introduction Due to the growing incidence of diabetes mellitus and advancing age of patients, there has been a rapid increase in the number of patients on dialysis. These patients are at higher risk of thrombotic complications requiring long term antiplatelet and anticoagulant medications, increasing their risk for bleeding. The most serious source of bleeding is gastrointestinal (GI) bleeding, which accounts for 2.5% of dialysis patients per year. This study was undertaken to determine the incidence and risk factors of GI bleeding in dialysis patients.

Methods A retrospective study was carried out in a UK district general hospital. Data was collected on all patients that were on haemodialysis and peritoneal dialysis until August 2015. Co-morbidities, medication lists, blood results and endoscopy findings were collated and analysed.

Results A total of 239 patients were identified to be on dialysis. The incidence of GI bleeds in dialysis patients was 7.9%. The average time from the start of dialysis to the time of bleed was 3 years. The average Hb, platelet count and INR was 68 g/L, 260, and 2.7 respectively. The most common findings on endoscopy included peptic ulcer disease (15.8%), haemorrhoids (15.8%), diverticular disease (15.8%), polyps (10.5%) and normal findings (10.5%). Patients with two or more co-morbidities had a 68% risk of bleeding compared to 54% who had one co-morbidity. Patients on two or more offending medication had a 15.8% risk of bleeding compared to 26.8% who were on single medication therapy. 42% of patients who had a GI bleed required a blood transfusion and 21% needed intervention during endoscopy. See table 1 for full details on risk factors associated with GI bleeding.

Abstract PTH-002 Table 1

Factors associated with gastrointestinal bleeding in dialysis patients

Conclusion There was a higher incidence of GI bleeding in our study as compared with the literature. We identified risk factors as being on anticoagulation, older age, male and having multiple co-morbidities. Being on more than one offending medication or on gastroprotective agents did not suggest higher risk of bleeding.

Disclosure of Interest None Declared

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