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Open Access Research article

The risk of upper gastrointestinal bleeding in patients treated with hemodialysis: a population-based cohort study

Chien-Chun Kuo1, Hsin-Wei Kuo2, I-Ming Lee3, Chien-Te Lee1 and Chun-Yuh Yang34*

Author Affiliations

1 Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang-Gung Memorial Hospital and Chang-Gung University College of Medicine, Kaohsiung, Taiwan

2 Division of Nephrology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung, Taiwan

3 Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st RD, Kaohsiung 80708, Taiwan

4 Division of Environmental Health and Occupational Medicine, National Health Research Institute, Miaoli, Taiwan

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BMC Nephrology 2013, 14:15  doi:10.1186/1471-2369-14-15

Published: 16 January 2013



There are no prior studies that have estimated the risk of upper gastrointestinal bleeding (UGIB) among the dialysis population relative to the general population. The aim of this study was to examine the risk of UGIB among end-stage renal disease (ESRD) patients during a 6-year period following their initiation of hemodialysis (HD) therapy in Taiwan- a country with the highest incidence of ESRD in the world, using general population as an external comparison group.


Data were obtained from the Taiwan National health Insurance Research Database. In total, 796 patients who were beginning HD between 1999 and 2003 were recruited as the study cohort and 3,184 patients matched for age and sex were included as comparison cohort. Multivariate Cox proportional hazard regression models were used to adjust for confounding and to compare the 6-year UGIB-free survival rate between these two cohorts.


The incidence rate of UGIB (42.01 per 1000 person-year) was significantly higher in the HD cohort than in the control cohort (27.39 per 1000 person-years). After adjusting for potential confounders, the adjusted hazard ratios for UGIB during the 6-year follow-up periods for HD patients was 1.27 (95% CI=1.03-1.57) compared to patients in the comparison cohort.


We conclude that HD patients were at an increased risk for UGIB compared with the general population.

Upper gastrointestinal bleeding; End-stage renal disease; Cohort study