Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Horinouchi Hospital, Saitama, Japan.
J Gastroenterol Hepatol. 2021 Jan;36(1):112-117. doi: 10.1111/jgh.15110. Epub 2020 Jun 16.
Knowledge on the risk of gastrointestinal (GI) bleeding in hemodialysis patients is limited. We evaluated the risk of GI bleeding in hemodialysis patients compared with non-hemodialysis patients.
We performed a retrospective cohort study from 1996 to 2017 at the Graduate School of Medicine, University of Tokyo, and Horinouchi Hospital. We analyzed patients on hemodialysis for chronic renal failure and controls not on hemodialysis. The primary endpoint was GI bleeding. A survival analysis was performed to estimate the cumulative incidence and hazard ratio of GI bleeding.
A total of 14 451 patients were analyzed (417 hemodialysis and 14 034 non-hemodialysis patients). In total, 524 GI bleeding events occurred. Upper and lower GI bleeding occurred in 432 and 92 patients in the hemodialysis and non-hemodialysis groups, respectively. The most frequent source of upper and lower GI bleeding was gastric ulcer and colonic diverticular bleeding, respectively. The cumulative incidence of GI bleeding was 4.44% at 1 year, 7.15% at 3 years, and 10.40% at 5 years in hemodialysis patients; the respective rates were 2.35%, 2.98%, and 3.79% in non-hemodialysis patients during a mean follow-up period of 3.5 years. Hemodialysis was significantly associated with an increased risk of GI bleeding after adjustment (hazard ratio 1.67, P = 0.01, 95% confidence interval 1.13-2.50).
Hemodialysis patients had a GI bleeding rate of 10% over 5 years, and hemodialysis was a risk factor for GI bleeding.
关于血液透析患者胃肠道（GI）出血风险的知识有限。我们评估了与非血液透析患者相比，血液透析患者发生 GI 出血的风险。
我们在东京大学研究生院和堀之内医院进行了一项回顾性队列研究，时间范围为 1996 年至 2017 年。我们分析了慢性肾功能衰竭血液透析患者和未进行血液透析的对照患者。主要终点是 GI 出血。采用生存分析估计 GI 出血的累积发生率和风险比。
共分析了 14451 例患者（417 例血液透析和 14034 例非血液透析患者）。共有 524 例 GI 出血事件发生。血液透析和非血液透析组分别有 432 例和 92 例发生上 GI 和下 GI 出血。上 GI 和下 GI 出血的最常见来源分别是胃溃疡和结肠憩室出血。血液透析患者 GI 出血的累积发生率在 1 年时为 4.44%，在 3 年时为 7.15%，在 5 年时为 10.40%；在平均随访 3.5 年期间，非血液透析患者的相应发生率分别为 2.35%、2.98%和 3.79%。经过调整后，血液透析与 GI 出血风险增加显著相关（风险比 1.67，P=0.01，95%置信区间 1.13-2.50）。
血液透析患者在 5 年内的 GI 出血率为 10%，血液透析是 GI 出血的一个危险因素。
