Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Oct 16, 2019; 11(10): 504-514
Published online Oct 16, 2019. doi: 10.4253/wjge.v11.i10.504
Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample
Tooba Tariq, Patrick Karabon, Furqan B Irfan, Sachin Goyal, Matthew Masaru Mayeda, Austin Parsons, Stephanie Judd, Murray Ehrinpreis
Tooba Tariq, Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI 49008, United States
Patrick Karabon, Oakland University William Beaumont School of Medicine, Oakland University, Detroit, MI 48309, United States
Furqan B Irfan, Matthew Masaru Mayeda, Austin Parsons, College of Osteopathic Medicine, Michigan State University, East Lansing, MI 48824, United States
Sachin Goyal, Murray Ehrinpreis, Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University, Detroit, MI 48201, United States
Stephanie Judd, Department of Internal Medicine, Division of Gastroenterology, Detroit Medical Center/Wayne State University and John D Dingell VA Medical Center, Detroit, MI 48201, United States
Author contributions: Tariq T, Karabon P, Irfan FB, Goyal S, Mayeda MM, Parsons A, Judd S and Ehrinpreis M contributed equally to the work; Tariq T and Irfan FB conceptualized and designed the study; Karabon P carried out the analysis; Karabon P and Goyal S critically analyzed the study; Goyal S, Mayeda MM, Parsons A, Judd S and Ehrinpreis M drafted the manuscript; Judd S interpreted the results; Ehrinpreis M supervised the study; all authors reviewed and approved the final manuscript as submitted.
Institutional review board statement: This study was reviewed and approved
Informed consent statement: Patients were not required to give informed consent to the study because deidentified patient data was used from national healthcare database for the analysis of the study.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tooba Tariq, MD, Instructor, Resident Physician, Department of Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, United States. toobatariq31@gmail.com
Telephone: +1-217-9045659 Fax: +1-269-3376222
Received: June 13, 2019
Peer-review started: June 19, 2019
First decision: August 2, 2019
Revised: August 21, 2019
Accepted: September 11, 2019
Article in press: September 11, 2019
Published online: October 16, 2019
Abstract
BACKGROUND

Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding.

AIM

To determine the nationwide prevalence, trends, predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations.

METHODS

The Nationwide Inpatient Sample database from 2009 to 2014, was utilized to conduct a retrospective study on patients with angiodysplasia associated- gastrointestinal bleeding and end-stage renal disease. Hospitalizations with end-stage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasia-associated gastrointestinal bleeding were identified with International Classification of Diseases, 9th revision, Clinical Modification codes for both end-stage renal disease (585.6) and Angiodysplasia (569.85, 537.83).

RESULTS

The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45% (n = 24709) among all end-stage renal disease patients (n = 5505252) that were hospitalized. Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients: an increasing trend from 2009-2014 (P < 0.01), increasing age (P < 0.0001); African American race (P = 0.0206); increasing Charlson-Deyo Comorbidity Index (P < 0.01); hypertension (P < 0.0001); and tobacco use (P < 0.0001). Diabetes mellitus (P < 0.0001) was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients. In comparison with urban teaching hospitals, rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage.

CONCLUSION

Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014. Advanced age, African American race, overall high comorbidities, hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalized patients.

Keywords: Angiodysplasia, Renal, Gastrointestinal, Hemorrhage

Core tip: There was an increasing trend of angiodysplasia associated-gastrointestinal bleeding among end-stage renal disease patients over the study period of 2009-2014. The likelihood of angiodysplasia associated-gastrointestinal bleeding significantly increased with advanced age with the highest likelihood occurring in patients above the age of 75 years. African American race, increased co-morbidities, hypertension and tobacco use were independent predictors of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease hospitalized patients.