Incidence and types of gastrointestinal bleeding episodes in dialysis

Abstract Background and Aims Gastrointestinal bleeding (GIB) has been suggested to be the most frequent cause of bleeding events in the dialysis population [1]. Despite this, there are scarce reports showing GIB incidence in large cohorts and the occurrence of specific GIB types is unknown. We used data on a nationally representative sample of dialysis patients treated at an integrated kidney care provider to characterize the incidence of GIB episodes by the type of bleed and location of diagnosis. Method We used data from dialysis patients treated in the United States during 01-Jan-2018 to 31-Mar-2021. GIB episodes were identified from international classification of diseases (ICD) diagnosis codes recorded as a comorbid condition during dialysis care, or as the primary, secondary, or tertiary discharge reason for hospitalization. ICD clusters for GIB episodes/types were based on the United States Healthcare Cost and Utilization Project [2]. GIB incidence rates were calculated per 1000 patient-years (p1000py). Results Among a population of 405,530 dialysis patients, 6.7% (n = 27,087) of patients experienced ≥1 GIB episode. There was a total of 56,454 GIB observations, of which 17,602 were recorded as a comorbid condition (n = 12,350 patients), 38,852 were recorded as the hospitalization cause (n = 25,315 patients). Overall, 26.4% (n = 5289) of dialysis patients were diagnosed with a GIB comorbidity and had a GIB hospitalization. The GIB incidence rate was 13.4 p1000py for a GIB comorbidity and 29.5 p1000py for a GIB hospitalization. The highest incidence rates among GIB types were found for unspecified GIBs (6.9 p1000py GIB comorbidity & 19.3 p1000py GIB hospitalization), followed by upper GIBs (5.5 p1000py GIB comorbidity & 6.2 p1000py GIB hospitalization), and then lower GIBs (1.0 p1000py GIB comorbidity & 4.0 p1000py GIB hospitalization). Considering upper GIB subtypes, ulcers/perforation below the esophagus were the most common comorbidity and hospitalization cause (Table 1). For lower GIB subtypes, a hemorrhage of the rectum and anus were the most common comorbidity and hospitalization cause. Conclusion The GIB incidence rate is about 7-fold higher in the dialysis population compared to the general population [3]. GIB appears to commonly be diagnosed during a hospitalization without any known comorbid condition, emphasizing a potential need for improved detection in the provision of outpatient dialysis care. Most GIB episodes were classified as an unspecified type, which shows a possible need for improved evaluation and/or coding. Further investigations are needed to understand the mortality rate after a GIB episode and should consider adjustments for age and sex.