Erschienen in:Clinical Journal of the American Society of Nephrology
Sprache:
Englisch
DOI:
10.2215/cjn.02170216
ISSN:
1555-9041;
1555-905X
Entstehung:
Anmerkungen:
Beschreibung:
<jats:sec>
<jats:title>Background and objectives</jats:title>
<jats:p>Patients on dialysis are known to have higher risk for gastrointestinal (GI) bleeding. However, data on mild to moderate CKD, particularly elevated albuminuria, are limited.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design, setting, participants, & measurements</jats:title>
<jats:p>Among 11,088 participants in the Atherosclerosis Risk in Communities (ARIC) Study, we investigated the association of eGFR and urinary albumin-to-creatinine ratio (ACR) with risk for hospitalization with GI bleeding. Kidney measures were assessed at visit four (1996–1998), and follow-up was continued through 2011.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>During a median follow-up of 13.9 years, 686 first incident hospitalizations with GI bleeding were observed (incidence rate, 4.9 per 1000 person-years [95% confidence interval (95% CI), 4.5 to 5.3]). Multivariable Cox proportional hazards models revealed that both lower eGFR and higher ACR were associated with higher risk for GI bleeding. With eGFR≥90 ml/min per 1.73 m<jats:sup>2</jats:sup> as a reference, risk for GI bleeding was significant in moderately decreased eGFR of 30–59 ml/min per 1.73 m<jats:sup>2</jats:sup> (hazard ratio [HR], 1.51; 95% CI, 1.13 to 2.02), and was highest in severely decreased eGFR<30 ml/min per 1.73 m<jats:sup>2</jats:sup> (HR, 7.06; 95% CI, 3.91 to 12.76). Compared with ACR<10 mg/g, risk for GI bleeding became significantly higher in mild albuminuria with ACR 10–29 mg/g (HR, 1.36; 95% CI, 1.08 to 1.69), and was nearly double in moderate and severe albuminuria (HR, 2.13; 95% CI, 1.66 to 2.71 for ACR 30–299 mg/g, and HR, 2.07; 95% CI, 1.33 to 3.22 for ACR≥300 mg/g). These results were largely consistent in demographic and clinical subgroups and independent of incident cardiovascular events or dialysis during follow-up.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusions</jats:title>
<jats:p>Individuals with even mild to moderate CKD warrant clinical attention regarding the risk of hospitalization with GI bleeding.</jats:p>
</jats:sec>