Long-term risk of upper gastrointestinal hemorrhage after advanced AKI

Abstract

Background and objectives There are few reports on temporary dialysis-requiring AKI as a risk factor for future upper gastrointestinal bleeding (UGIB). This study sought to explore the long-termassociation between dialysisrequiring AKI and UGIB. Design, setting, participants, &measurements This nationwide cohort study used data fromthe Taiwan National Health Insurance Research Database. Patients who recovered from dialysis-requiring AKI and matched controls were selected from hospitalized patients age $18 years between 1998 and 2006. The cumulative incidences of long-term de novo UGIB were calculated, and the risk factors of UGIB and mortality were identified using timevarying Cox proportional hazard models adjusted for subsequent CKD and ESRD after AKI. Results A total of 4565 AKI-recovery patients and the same number of matched patients without AKI were analyzed. After amedian follow-up time of 2.33 years (interquartile range, 0.97–4.81 years), the incidence rates of UGIB were 50 (by stringent criterion) and 69 (by lenient criterion) per 1000 patient-years in the AKI-recovery group and 31 (by stringent criterion) and 48 (by lenient criterion) per 1000 patient-years in the non-AKI group (both P,0.001). When compared with patients in the non-AKI group, the multivariate hazard ratio (HR) for UGIB was 1.30 (95% confidence interval [95% CI], 1.14 to 1.48) for dialysis-requiring AKI, 1.83 (95% CI, 1.53 to 2.20) for time-varying CKD, and 2.31 (95% CI, 1.92 to 2.79) for time-varying ESRD (all P,0.001). Finally, the risk for long-term mortality increased after UGIB (HR, 1.24; 95% CI, 1.12 to 1.38) and dialysis-requiring AKI (HR, 1.66; 95% CI, 1.54 to 1.78). Conclusions Recovery from dialysis-requiring AKI was associated with future UGIB and mortality.