Even Mild CKD Raises Gastrointestinal Bleeding Risk

Higher albuminuria emerges as a significant predictor of hospitalization for GI bleeding.
Higher albuminuria emerges as a significant predictor of hospitalization for GI bleeding.

Patients with mild to moderate chronic kidney disease (CKD) are at increased risk for gastrointestinal (GI) bleeding, new data suggest.

The data are from a study of 11,088 participants in the Atherosclerosis Risk in Communities (ARIC) study. During a median follow-up of 13.9 years, investigators observed 686 first incident hospitalizations for GI bleeding, an incidence rate of 4.9 episodes per 1000 person-years. In multivariable analysis, lower estimated glomerular filtration rate (eGFR) and higher albumin-to-creatinine ratio (ACR) were independently associated with high risk of hospitalization for GI bleeding.

Compared with individuals who had an eGFR of 90 mL/min/1.73 m2 or higher, those with an eGFR of 30 to 59 and less than 30 mL/min/1.73 m2 had a 51% and 7-fold increased risk of hospitalization for GI bleeding, respectively, a team led by Kunhiro Matsushita, MD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, reported online ahead of print in the Clinical Journal of the American Society of Nephrology.

In addition, compared with individuals who had an ACR below 10 mg/g, those with an ACR of 10 to 29, 30 to 299, and 300 mg/g or higher had a 36%, 2-fold, and 2-fold increased risk of hospitalization for GI bleeding, respectively.

“To our knowledge, this is the first study demonstrating the association of higher albuminuria with risk for GI bleeding,” the investigators stated.

The ARIC study includes a population-based cohort of individuals aged 45 to 64 years at the time of enrollment from 1987 to 1989 from 4 U.S. communities.

The patients who experienced GI bleeding were significantly older than those who did not (mean 64.8 vs 62.7 years) and significantly more likely to be using aspirin (65% vs56%), anticoagulants (6% vs 2%) and proton pump inhibitors (5% vs 3%).

The investigators discussed the possible clinical implications of their study findings. For example, physicians should be aware of the high risk of GI bleeding in individuals with decreased kidney function even at a moderate stage. In addition, they said their findings demonstrate that albuminuria is a potent predictor of GI bleeding. Its contribution to risk discrimination was similar to or even greater than most of the established predictors, they stated.

In an acknowledgement of study limitations, Dr Matsushita's group noted that they relied on ICD-9 codes to ascertain the outcome of GI bleeding. Still, they noted, the validity of ICD-9 codes to identify GI bleeding has been reported to be high. In addition, since their study was observational, they could not exclude the possibility of residual confounding. Lastly, their study looked at a middle-aged biethnic population, so it is unclear if their results can be generalizable to other races and age ranges.

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