The Study On The Rate Of Gastrointestinal Bleeding And Risk Factors In Dialysis Patients With End-stage Renal Disease

BackgroundGastrointestinal bleeding is one of the common critical diseases,which seriously threatens human life and health.Recently,many studies have found that gastrointestinal bleeding is more and more frequent in end-stage renal disease patients.What is the incidence rate of gastrointestinal bleeding in end-stage renal dialysis patients?Is the risk higher than that of the general population?What are the related factors of gastrointestinal bleeding in dialysis patients?There is no unified conclusion in the literature.This study was designed to investigate the incidence rate of gastrointestinal bleeding in dialysis patients,and to study the factors associated with gastrointestinal bleeding,in order to provide evidence for early clinical intervention.ObjectiveThe aim of this study is to investigate the incidence rate and related factors of gastrointestinal bleeding in dialysis patients with end-stage renal disease.MethodPatients with end-stage renal disease who underwent regular dialysis in nephrology department of our hospital from January 1,2012 to December 31,2019 were included.The basic information of patients,including gender,age,primary kidney disease,dialysis method,and whether gastrointestinal bleeding occurred during regular dialysis were collected and recorded.The laboratory data 3 months after regular dialysis were collected as baseline data.Firstly,the incidence rate of gastrointestinal bleeding in dialysis patients was statistically analyzed.According to the occurrence of gastrointestinal bleeding,the patients were divided into gastrointestinal bleeding group and non-gastrointestinal bleeding group.Nonparametric test was used to compare and analyze the differences between the basic information and laboratory indicators of the two groups.The indicators with statistical significance in the preliminary analysis and those clinically considered to be significant were included in the binary logistic regression analysis to further explore the influencing factors of gastrointestinal bleeding in dialysis patients.Results1.A total of 412 uremic dialysis patients were included in the study,with an average age of(55.21 ± 15.70)years.There were 243 males(58.98%)and 169 females(41.02%),155 hemodialysis patients(37.62%),257 peritoneal dialysis patients(62.38%),127 primary renal diseases were chronic glomerulonephritis,69 hypertensive nephropathy,59 obstructive nephropathy,126 diabetic nephropathy,and others(polycystic kidney disease)There were 31 patients with lupus nephritis,hepatitis B associated nephritis and gouty nephropathy.There were 290 patients with cardiovascular and cerebrovascular diseases,and 122 patients without cardiovascular and cerebrovascular diseases.Of these,48 patients had gastrointestinal bleeding,with a incidence rate of 11.65%.2.2.Chi square test,t test and nonparametric rank sum test were used to analyze the differences of each index between the two groups.The study found that gender(x2=0.167,P=0.682),age(t=-0.998,P=0.319),dialysis mode(x2=0.379,P=0.538),primary renal disease(x2=9.347,P=0.053)and whether complicated with cardiovascular and cerebrovascular diseases(x2=2.009,P=0.156)had no significant effect on gastrointestinal bleeding.There were significant differences in erythrocyte count(U=6251.5,P=0.001),hemoglobin(U=5890.5,P<0.001),albumin(U=5974,P<0.001),gamma glutamyl transpeptidase(U=7156.5,P=0.041),uric acid(U=6705,P=0.009)and calcium(U=5977,P<0.01).3.Binary logistic regression showed that patients with normal albumin had a lower risk of gastrointestinal bleeding than patients with low albumin(OR=0.371,95%CI:0.151-0.912,P=0.031).No anemia(OR=0.098,95%CI:0.011-0.899,P=0.040)and mild anemia(OR=0.057,95%CI:0.006-0.508,P=0.010)were significantly lower than severe anemia.Patients with blood calcium more than 2.30 mmol/1 had a lower risk of gastrointestinal bleeding than those with blood calcium less than 2.01 mmol/L(OR=0.205,95%CI,0.064-0.661,P=0.008).Conclusion1.The rate of gastrointestinal bleeding in dialysis patients is as high as 11.65%.2.Hypoalbuminemia,severe and very severe anemia,blood calcium less than 2.01 mmol/L are the risk factors of gastrointestinal bleeding in dialysis patients with end-stage renal disease.