A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease

Dushyant Singh Dahiya; Sohaib Mandoorah; Manesh Kumar Gangwani; Hassam Ali; Nooraldin Merza; Muhammad Aziz; Amandeep Singh; Abhilash Perisetti; Rajat Garg; Chin-I Cheng; Priyata Dutta; Sumant Inamdar; Madhusudhan R Sanaka; Mohammad Al-Haddad

doi:10.14740/gr1605

A Comparative Analysis of Bleeding Peptic Ulcers in Hospitalizations With and Without End-Stage Renal Disease

Gastroenterology Res. 2023 Feb;16(1):17-24. doi: 10.14740/gr1605. Epub 2023 Feb 28.

Authors

Dushyant Singh Dahiya^{1

2}, Sohaib Mandoorah^{3

2}, Manesh Kumar Gangwani⁴, Hassam Ali⁵, Nooraldin Merza⁴, Muhammad Aziz⁶, Amandeep Singh⁷, Abhilash Perisetti⁸, Rajat Garg⁷, Chin-I Cheng⁹, Priyata Dutta¹⁰, Sumant Inamdar¹¹, Madhusudhan R Sanaka⁷, Mohammad Al-Haddad¹²

Affiliations

¹ Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
² These authors contributed equally to this article.
³ Division of Pulmonary and Critical Care Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.
⁴ Department of Internal Medicine, The University of Toledo Medical Center, Toledo, OH, USA.
⁵ Department of Internal Medicine, East Carolina University, Greenville, NC, USA.
⁶ Department of Gastroenterology and Hepatology, The University of Toledo Medical Center, Toledo, OH, USA.
⁷ Department of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁸ Division of Gastroenterology and Hepatology, Kansas City Veterans Affairs Medical Center, Kansas City, MO, USA.
⁹ Department of Statistics, Actuarial and Data Science, Central Michigan University, Mt Pleasant, MI, USA.
¹⁰ Department of Internal Medicine, Trinity Health, Ann Arbor, MI, USA.
¹¹ Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
¹² Division of Gastroenterology and Hepatology, Indiana University School of Medicine Indianapolis, IN, USA.

PMID: 36895703
PMCID: PMC9990529
DOI: 10.14740/gr1605

Abstract

Background: End-stage renal disease (ESRD) patients are highly susceptible to peptic ulcer bleeding (PUB). We aimed to assess the influence of ESRD status on PUB hospitalizations in the United States (USA).

Methods: We analyzed the National Inpatient Sample to identify all adult PUB hospitalizations in the USA from 2007 to 2014, which were divided into two subgroups based on the presence or absence of ESRD. Hospitalization characteristics and clinical outcomes were compared. Furthermore, predictors of inpatient mortality for PUB hospitalizations with ESRD were identified.

Results: Between 2007 and 2014, there were 351,965 PUB hospitalizations with ESRD compared to 2,037,037 non-ESRD PUB hospitalizations. PUB ESRD hospitalizations had a higher mean age (71.6 vs. 63.6 years, P < 0.001), and proportion of ethnic minorities i.e., Blacks, Hispanics, and Asians compared to the non-ESRD cohort. We also noted higher all-cause inpatient mortality (5.4% vs. 2.6%, P < 0.001), rates of esophagogastroduodenoscopy (EGD) (20.7% vs. 19.1%, P < 0.001), and mean length of stay (LOS) (8.2 vs. 6 days, P < 0.001) for PUB ESRD hospitalizations compared to the non-ESRD cohort. After multivariate logistic regression analysis, Whites with ESRD had higher odds of mortality from PUB compared to Blacks. Furthermore, the odds of inpatient mortality from PUB decreased by 0.6% for every 1-year increase in age for hospitalizations with ESRD. Compared to the 2011 - 2014 study period, the 2007 - 2010 period had 43.7% higher odds (odds ratio (OR): 0.696, 95% confidence interval (CI): 0.645 - 0.751) of inpatient mortality for PUB hospitalizations with ESRD.

Conclusions: PUB hospitalizations with ESRD had higher inpatient mortality, EGD utilization, and mean LOS compared to non-ESRD PUB hospitalizations.

Keywords: End-stage renal disease; Mortality; Peptic ulcer bleeding; Racial disparities; Upper gastrointestinal bleeding.