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Long-term peptic ulcer rebleeding risk estimation in patients undergoing haemodialysis: a 10-year nationwide cohort study
  1. Chun-Ying Wu1,2,3,4,
  2. Ming-Shiang Wu5,
  3. Ken N Kuo6,
  4. Chang-Bi Wang2,
  5. Yi-Ju Chen1,
  6. Jaw-Town Lin5,7
  1. 1Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  2. 2Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan
  3. 3Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
  4. 4Department of Life Sciences, National Chung-Hsing University, Taichung, Taiwan
  5. 5Division of Gastroenterology, National Taiwan University Hospital, Taipei, Taiwan
  6. 6Center for Health Policy Research and Development, National Health Research Institutes; Miaoli, Taiwan
  7. 7Department of Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung County, Taiwan
  1. Correspondence to Dr Chun-Ying Wu, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, 155, Sec. 2, Linong Street, Taipei 112, Taiwan; chun{at}vghtc.gov.tw

Abstract

Objective We aimed to study 1-, 5- and 10-year risks of peptic ulcer rebleeding among end-stage renal disease (ESRD) patients with regular haemodialysis, to identify the high-risk subpopulation, and to estimate the number needed to harm (NNH) to increase a peptic ulcer rebleeding in different periods.

Design A nationwide cohort study.

Setting Data from the Taiwan National Health Insurance Research Database.

Patients Uraemic cohort and matched controls were selected from among hospitalised patients with a primary diagnosis of peptic ulcer bleeding. In total, 6447 uraemic patients and 25 788 age-, gender- and gastroprotective agent use-matched controls were selected.

Intervention No.

Main outcome measures Cumulative incidences and HRs.

Results The cumulative incidences of ESRD patients were significantly higher than the cumulative incidences of matched controls (1 year: 18.8% vs 14.2%; 5 years: 38.5% vs 31.4%; and 10 years: 46.3% vs 39.4%; all p<0.001). The NNH to increase a peptic ulcer rebleeding by ESRD at 1, 5 and 10 years were 22, 15 and 15, respectively. On multivariate analysis, ESRD (HR=1.38, p<0.0001) was an independent risk factor for rebleeding. Compared with matched controls, ESRD was associated with higher risk of rebleeding especially in patients using ulcerogenic agents (HR=1.33–1.45), indication to prescribe gastroprotective agents (HR=1.44) and with liver cirrhosis (HR=1.45).

Conclusions ESRD patients had higher long-term risk of peptic ulcer rebleeding, especially in certain populations. The enhanced risk gradually decreased after the first year and stabilised after the fifth year.

  • Peptic ulcer
  • bleeding
  • end-stage renal disease (ESRD)
  • cirrhosis
  • H. pylori
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • bleeding peptic ulcer
  • liver cirrhosis

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Footnotes

  • C-Y Wu and J-T Lin contributed equally to this work as corresponding authors.

  • Funding This work was supported by the National Health Research Institutes of Taiwan (grant numbers: PH-099-PP-26 and PH-099-PP-16).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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