Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2017; 23(47): 8415-8425
Published online Dec 21, 2017. doi: 10.3748/wjg.v23.i47.8415
Chronic kidney disease severely deteriorates the outcome of gastrointestinal bleeding: A meta-analysis
Roland Hágendorn, Nelli Farkas, Áron Vincze, Zoltán Gyöngyi, Dezső Csupor, Judit Bajor, Bálint Erőss, Péter Csécsei, Andrea Vasas, Zsolt Szakács, László Szapáry, Péter Hegyi, Alexandra Mikó
Roland Hágendorn, Áron Vincze, Judit Bajor, Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs 7624, Hungary
Nelli Farkas, Institute of Bioanalysis, University of Pécs, Pécs 7624, Hungary
Zoltán Gyöngyi, Department of Public Health Medicine, University of Pécs, Pécs 7624, Hungary
Dezső Csupor, Andrea Vasas, Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
Bálint Erőss, Zsolt Szakács, László Szapáry, Péter Hegyi, Alexandra Mikó, Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
Péter Csécsei, Department of Neurology, University of Pécs, Pécs 7623, Hungary
Author contributions: Hegyi P and Mikó A contributed equally to this article; Hegyi P and Mikó A designed the research and the study concept; Hágendorn R and Mikó A performed the acquisition of data; Farkas N analysed and interpreted the data; Hágendorn R, Farkas N, Hegyi P and Mikó A wrote the paper; Vincze Á, Erőss B, Gyöngyi Z and Bajor J supervised the study; Csupor D, Csécsei P, Vasas A, Szakács Z and Szapáry L conducted a critical revision of the manuscript for important intellectual content; all of the co-authors granted final approval of the version of the article to be published.
Supported by Project Grants No. K116634 and KH125678 (to Hegyi P); Economic Development and Innovation Operative Programme Grant, No. GINOP 2.3.2-15-2016-00048 (to Hegyi P); Human Resources Development Operational Programme Grant No. EFOP-3.6.2-16-2017-00006 (to Hegyi P) of the National Research, Development; and Innovation Office and by a Momentum Grant of the Hungarian Academy of Sciences No. LP2014-10/2014 to (Hegyi P).
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Data sharing statement: No additional data are available.
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/
Correspondence to: Alexandra Mikó MD, PhD, Centre for Translational Medicine, University of Pécs, Szigeti Street 12., II. floor, Pécs 7624, Hungary, alexandra.miko@aok.pte.hu
Telephone: +36-72-536246 Fax: +36-72-536247
Received: October 30, 2017
Peer-review started: October 31, 2017
First decision: November 14, 2017
Revised: November 23, 2017
Accepted: December 4, 2017
Article in press: December 4, 2017
Published online: December 21, 2017
Processing time: 50 Days and 18.7 Hours
Abstract
AIM

To understand the influence of chronic kidney disease (CKD) on mortality, need for transfusion and rebleeding in gastrointestinal (GI) bleeding patients.

METHODS

A systematic search was conducted in three databases for studies on GI bleeding patients with CKD or end-stage renal disease (ESRD) with data on outcomes of mortality, transfusion requirement, rebleeding rate and length of hospitalization (LOH). Calculations were performed with Comprehensive Meta-Analysis software using the random effects model. Heterogeneity was tested by using Cochrane’s Q and I2 statistics. Mean difference (MD) and OR (odds ratio) were calculated.

RESULTS

1063 articles (EMBASE: 589; PubMed: 459; Cochrane: 15) were found in total. 5 retrospective articles and 1 prospective study were available for analysis. These 6 articles contained data on 406035 patients, of whom 51315 had impaired renal function. The analysis showed a higher mortality in the CKD group (OR = 1.786, 95%CI: 1.689-1.888, P < 0.001) and the ESRD group (OR = 2.530, 95%CI: 1.386-4.616, P = 0.002), and a rebleeding rate (OR = 2.510, 95%CI: 1.521-4.144, P < 0.001) in patients with impaired renal function. CKD patients required more unit red blood cell transfusion (MD = 1.863, 95%CI: 0.812-2.915, P < 0.001) and spent more time in hospital (MD = 13.245, 95%CI: 6.886-19.623, P < 0.001) than the controls.

CONCLUSION

ESRD increases mortality, need for transfusion, rebleeding rate and LOH among GI bleeding patients. Prospective patient registries and observational clinical trials are crucially needed.

Keywords: Gastrointestinal bleeding; Chronic kidney disease; Mortality; Blood transfusion; Rebleeding

Core tip: Acute gastrointestinal bleeding is a potentially life-threatening abdominal emergency that remains a common cause of hospitalization. Pre-existing chronic kidney disease (CKD) may worsen the prognosis. This is the first meta-analysis to compare CKD patients and normal renal function patients based on GI bleeding. We investigated these two groups in terms of mortality, transfusion amount, rebleeding rate and length of hospitalization.