Abstract: TH-OR45
Inpatient Outcomes of Gastrointestinal Bleeding in Advanced CKD: A National Analysis, 2016-2019
Session Information
- CKD: Novel Risk Factors and Consequences
October 24, 2024 | Location: Room 24, Convention Center
Abstract Time: 05:50 PM - 06:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- He, Mingyue, Temple University Hospital, Philadelphia, Pennsylvania, United States
- Desai, Shaan H., Temple University Hospital, Philadelphia, Pennsylvania, United States
- Wang, Yichen, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
- Gillespie, Avrum, Temple University Hospital, Philadelphia, Pennsylvania, United States
Background
Patients with Advanced Chronic Kidney Disease (ACKD) and End-Stage Kidney Disease (ESKD) have an elevated risk of Gastrointestinal Bleeding (GIB). This study aims to investigate the incidence, causes, interventions, and outcomes of GIB among these groups compared to patients without CKD (NCKD).
Methods
Using the Nationwide Inpatient Sample, we analyzed non-elective admissions for GIB from 2016 to 2019, encompassing upper, lower, and unspecified GIB cases across ACKD (CKD stages 4 or 5), ESKD, and NCKD groups. We compared various outcomes and conducted subgroup analyses based on the timing of endoscopy within the ACKD and ESKD cohorts.
Results
The study included 2,163,929 patients. The incidence of GIB hospitalizations was higher in the ACKD (3.2%) and ESKD (3.4%) groups compared to NCKD (2.2%). ACKD and ESKD patients exhibited increased mortality (adjusted Odds Ratio 1.33 and 1.94, respectively; p<0.001) compared to NCKD. Patients with ESKD demonstrated increased rates of mechanical ventilation, pressor support, and blood transfusion, along with prolonged and costly hospitalizations (p < 0.001 for all). There was decreased early endoscopic evaluation (<24 h) and increased late evaluations (> 48h) in the ACKD and ESKD groups (p < 0.001 for all) compared to NCKD. Multivariate analysis revealed that early endoscopy was significantly associated with decreased mortality while delayed endoscopy was significantly associated with increased mortality in ACKD and ESKD patients (p<=0.001 for all). The primary causes of GIB in both the ACKD and ESKD groups were gastric/duodenal bleeding and angiodysplasia bleeding. ACKD and ESKD were independent risk factors for angiodysplasia bleeding.
Conclusion
ACKD and ESKD are independent risk factors for GIB and in-hospital mortality. ESKD patients with GIB demonstrated significantly elevated rates of adverse outcomes compared to those without CKD. Both groups had a lower rate of early endoscopy and a higher rate of delayed endoscopy, which emerged as independent risk factors for mortality. Further investigation to understand the reasons for delayed endoscopic evaluations in ESKD patients is crucial for improving patient outcomes.