Üst gastrointestinal sistem kanamalı hastalarda kronik böbrek yetmezliğinin risk faktörleri ve endoskopi sonuçlarına etkisinin değerlendirilmesi
Öz
Amaç: Akut üst
gastrointestinal sistem (GİS) kanamaları sık karşılaşılan mortalite ve
morbidite nedenlerindendir. Üst GİS kanamalarında ek hastalık varlığı mortalite
ile ilişkili bir risk faktörü olup kronik böbrek yetmezliği de (KBY) bunlardan
biridir. Bu çalışmamızda, Tepecik Eğitim Araştırma Hastanesi Gastroenteroloji Kliniği’nde
Ocak 2016-Ocak 2017 tarihleri arasında yatırılarak tedavi altına alınan üst GİS
kanaması geçiren KBY’li hastalar ile üst GİS kanaması geçiren renal yetmezliği
olmayan hastalar demografik özellikler, ek hastalık varlığı, ilaç kullanımı,
endoskopik sonuçlar, Forrest sınıflaması ve endoskopik girişim gereksinimi ve
mortalite açısından karşılaştırmalı olarak incelendi.
Gereç ve Yöntem: Toplam 194
hasta retrospektif olarak değerlendirilmeye alındı. Glomerüler filtrasyon hızı
(GFR) 60 mL/dk/1.73 m2’nin altı olan kronik böbrek yetmezliği
grubunda 90 hasta, GFR 60 mL/dk/1.73 m2’nin ve üzerinde olan kontrol
grubunda ise 104 hasta çalışmaya dahil edildi.
Bulgular: Çalışma
sonucunda KBY grubunun daha yaşlı olduğu ve bu grupta hastaların %96’sında
eşlik eden ek hastalık varlığı saptandı. İlaç kullanımı kontrol grubundan daha
yüksekti ve en sık kullanılan ilaç olarak aspirin tespit edildi. Olguların %
70’inden fazlasına ilk gün endoskopi uygulandı.
Sonuç: KBY grubunda
hastane mortalite oranı kontrol grubuna göre yüksekti (%5.66’ye %2.88, p=0.475)
ve total mortalite oranlarımız literatüre göre daha düşük tespit edildi.
Anahtar Kelimeler
Kaynakça
- Hernández-Dı́az S, Rodríguez LA. Incidence of serious upper gastrointestinal bleeding/perforation in the general population: Review of epidemiologic studies. J Clin Epidemiol 2002;55(2):157-63.
- Kapsoritakis AN, Ntounas EA, Makrigiannis EA, et al. Acute upper gastrointestinal bleeding in central Greece: The role of clinical and endoscopic variables in bleeding outcome. Dig Dis Sci 2009;54(2):333-41.
- Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: A meta-analysis. Gastroenterology 1992;102(1):139-48.
- Sood P, Kumar G, Nanchal R, et al. Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol 2012;35(3):216-24.
- Milito G, Taccone-Gallucci M, Brancaleone C, et al. Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation. Am J Gastroenterol 1983;78(6):328-31.
- Boyle JM, Johnston B. Acute upper gastrointestinal hemorrhage in patients with chronic renal disease. Am J Med 1983;75(3):409-12.
- Wasse H, Gillen DL, Ball AM, et al. Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int 2003;64(4):1455-61.
- Zaltman C, Souza HS, Castro ME, Sobral De F, Dias PC, Lemos V Jr. Upper gastrointestinal bleeding in a Brazilian hospital: A retrospective study of endoscopic records. Arq Gastroenterol 2002;39(2):74-80.
- Theocharis GJ, Arvaniti V, Assimakopoulos SF, et al. Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality. World J Gastroenterol 2008;14(25):4047-53.
- Sánchez Perales MC, Vázquez E, García Cortés MJ, et al. Platelet antiaggregation and hemorrhagic risk in hemodialysis. Nefrologia 2002;22(5):456-62.
- Gado AS, Ebeid BA, Abdelmohsen AM, Axon AT. Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt. Saudi J Gastroenterol 2012;18(1):34-9.
- Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: Patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011;60(10):1327-35.
- Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: Role of vascular ectasia. Am J Gastroenterol 1996;91(11):2329-32.
- Golánová J, Hrdlicka L, St'ovícek J, et al. Acute hemorrhage of the upper part of the gastrointestinal tract survey of emergency endoscopy of the upper gastrointestinal tract at our facility. Vnitr Lek 2004;50(4):274-7.
- Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 1985;102(5):588-92.
- Lee YJ, Kim ES, Hah YJ, et al. Chronic kidney disease, hemodynamic instability, and endoscopic high-risk appearance are associated with 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. J Korean Med Sci 2013;8(10):1500-6.
- Parasa S, Navaneethan U, Sridhar AR, Venkatesh PG, Olden K. End-stage renal disease is associated with worse outcomes in hospitalized patients with peptic ulcer bleeding. Gastrointest Endosc 2013;77(4):609-16.
- Weng SC, Shu KH, Tarng DC, et al. In-hospital mortality risk estimation in patients with acute nonvariceal upper gastrointestinal bleeding undergoing hemodialysis: A retrospective cohort study. Ren Fail 2013;35(2):243-8.
Effects of chronic renal insufficiency on risk factors and results of endoscopy in patients with upper gastrointestinal system bleeding
Öz
Aim: Acute upper
gastrointestinal system (GIS) bleeding is one of the leading causes of
mortality and morbidity. Presence of concomitant disease in upper GIS bleeding
is a mortality-associated risk factor, and chronic renal insufficiency (CRI) is
one of these concomitant diseases. In the present study, patients with CRI, who
had upper GIS bleeding and been treated as inpatient between January 2016 and
January 2017 at Tepecik Training and Research Hospital Clinic of
Gastroenterology, and the patients that had upper GIS bleeding without renal
insufficiency were comparatively investigated in terms of demographic
characteristics, presence of concomitant disease, drug usage, endoscopic
results, Forrest classification, and need for endoscopic intervention and
mortality.
Materials
and Methods: A total of 194 patients were retrospectively
evaluated. The CRI group with a glomerular filtration rate (GFR) lower than 60
mL/min/1.73 m2 comprised 90 patients, whereas the control group with
a GFR of 60 mL/min/1.73 m2 and higher comprised 104 patients.
Results: As the
result of the study, it was determined that CRI group was older and 96% of the
patients had a concomitant disease. Drug usage rate was higher than the control
group with aspirin used most frequently. Endoscopy was performed on Day 1 in
more than 70% of the cases.
Conclusion: Hospital
mortality rate was higher in CRI group (5.66% vs 2.88%, p=0.475) with lower
total mortality rate found in the present study as compared to the literature.
Anahtar Kelimeler
Chronic renal insufficiency gastrointestinal bleeding mortality.
Kaynakça
- Hernández-Dı́az S, Rodríguez LA. Incidence of serious upper gastrointestinal bleeding/perforation in the general population: Review of epidemiologic studies. J Clin Epidemiol 2002;55(2):157-63.
- Kapsoritakis AN, Ntounas EA, Makrigiannis EA, et al. Acute upper gastrointestinal bleeding in central Greece: The role of clinical and endoscopic variables in bleeding outcome. Dig Dis Sci 2009;54(2):333-41.
- Cook DJ, Guyatt GH, Salena BJ, Laine LA. Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: A meta-analysis. Gastroenterology 1992;102(1):139-48.
- Sood P, Kumar G, Nanchal R, et al. Chronic kidney disease and end-stage renal disease predict higher risk of mortality in patients with primary upper gastrointestinal bleeding. Am J Nephrol 2012;35(3):216-24.
- Milito G, Taccone-Gallucci M, Brancaleone C, et al. Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation. Am J Gastroenterol 1983;78(6):328-31.
- Boyle JM, Johnston B. Acute upper gastrointestinal hemorrhage in patients with chronic renal disease. Am J Med 1983;75(3):409-12.
- Wasse H, Gillen DL, Ball AM, et al. Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients. Kidney Int 2003;64(4):1455-61.
- Zaltman C, Souza HS, Castro ME, Sobral De F, Dias PC, Lemos V Jr. Upper gastrointestinal bleeding in a Brazilian hospital: A retrospective study of endoscopic records. Arq Gastroenterol 2002;39(2):74-80.
- Theocharis GJ, Arvaniti V, Assimakopoulos SF, et al. Acute upper gastrointestinal bleeding in octogenarians: Clinical outcome and factors related to mortality. World J Gastroenterol 2008;14(25):4047-53.
- Sánchez Perales MC, Vázquez E, García Cortés MJ, et al. Platelet antiaggregation and hemorrhagic risk in hemodialysis. Nefrologia 2002;22(5):456-62.
- Gado AS, Ebeid BA, Abdelmohsen AM, Axon AT. Clinical outcome of acute upper gastrointestinal hemorrhage among patients admitted to a government hospital in Egypt. Saudi J Gastroenterol 2012;18(1):34-9.
- Hearnshaw SA, Logan RF, Lowe D, Travis SP, Murphy MF, Palmer KR. Acute upper gastrointestinal bleeding in the UK: Patient characteristics, diagnoses and outcomes in the 2007 UK audit. Gut 2011;60(10):1327-35.
- Chalasani N, Cotsonis G, Wilcox CM. Upper gastrointestinal bleeding in patients with chronic renal failure: Role of vascular ectasia. Am J Gastroenterol 1996;91(11):2329-32.
- Golánová J, Hrdlicka L, St'ovícek J, et al. Acute hemorrhage of the upper part of the gastrointestinal tract survey of emergency endoscopy of the upper gastrointestinal tract at our facility. Vnitr Lek 2004;50(4):274-7.
- Zuckerman GR, Cornette GL, Clouse RE, Harter HR. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med 1985;102(5):588-92.
- Lee YJ, Kim ES, Hah YJ, et al. Chronic kidney disease, hemodynamic instability, and endoscopic high-risk appearance are associated with 30-day rebleeding in patients with non-variceal upper gastrointestinal bleeding. J Korean Med Sci 2013;8(10):1500-6.
- Parasa S, Navaneethan U, Sridhar AR, Venkatesh PG, Olden K. End-stage renal disease is associated with worse outcomes in hospitalized patients with peptic ulcer bleeding. Gastrointest Endosc 2013;77(4):609-16.
- Weng SC, Shu KH, Tarng DC, et al. In-hospital mortality risk estimation in patients with acute nonvariceal upper gastrointestinal bleeding undergoing hemodialysis: A retrospective cohort study. Ren Fail 2013;35(2):243-8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 3 Aralık 2018 |
| Gönderilme Tarihi | 7 Kasım 2017 |
| Yayımlandığı Sayı | Yıl 2018Cilt: 57 Sayı: 4 |
