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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
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
ARTICLE HIGHLIGHTS
Research background
Chronic kidney disease is a significant comorbidity, which can worsen the outcomes of gastrointestinal (GI) bleeding.
Research motivation
We wanted to understand the role of chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the natural history of GI bleeding.
Research objectives
Our goal was to investigate the influence of CKD and ESRD on the outcomes of GI bleeding, based on all available data published in this topic.
Research methods
A comprehensive search was carried out in PubMed, Embase and Cochrane Library databases for studies detailing the outcomes of GI bleeding in the context of kidney functions. We used the PRISMA P protocol, registered our project through PROSPERO and assessed the quality of the included articles by using the Newcastle-Ottawa Scale, to ensure that this meta-analysis is done to the highest possible standards. The statistical calculations were performed with Comprehensive Meta-Analysis software, using the random effects model (DerSimonian-Laird method).
Research results
In this analysis 51315 patients with CKD and 354720 controls were included (6 articles). We found that the mortality of GI bleeding was significantly worse in CKD and ESRD with an OR of 1.79 and 2.53 respectively. Patients with kidney disease needed significantly more transfusion with a MD of 1.86 and the rebleeding rate was significantly worse in the group with impaired kidney function with an OR of 2.51. Patients with impaired kidney function needed significantly longer hospitalization with a MD of 13.25.
Research conclusions
This is the first meta-analysis and systematic review in this topic, which quantifies kidney disease as a negative risk factor in GI bleeding. GI bleeding in patients with chronic renal failure significantly increases the mortality rate, rebleeding rate, length of hospitalization, and require more blood transfusion compared to patients with normal kidney functions. Kidney disease significantly worsens the outlook of patients presenting with GI bleeding. Patients with chronic kidney disease will need to be treated with more caution due to the worse outcomes of GI bleeding. Close monitoring of the fluid balance and kidney functions, careful fluid therapy and prevention of acute kidney injury in these patients may improve the outcomes of GI bleeding.
Research perspectives
Although CKD, ESRD, and other comorbidities are major risk factors for unfavorable outcomes in GI bleeding, their roles are not well investigated nor understood and they need further scrutiny. We would better understand the role of CKD in ESRD in GI bleeding from analysis of extensive data from large multicenter and multinational observational studies and registries accurately recording the outcomes and the kidney functions.
