Is end stage renal disease a risk factor for the mortality of cirrhotic patients with esophageal variceal bleeding?

BACKGROUND/AIMS: End stage renal disease (ESRD) patients are prone to have bleeding due to uremic platelet dysfunction. However, it is still unknown if ESRD is a risk factor for the mortality of cirrhotic patients with esophageal variceal bleeding (EVB).

METHODOLOGY: The National Health Insurance Database, derived from the Taiwan National Health Insurance Program, was used to enroll 6740 cirrhotic patients who were hospitalized with EVB from January 1 to December 31, 2007. The patients were matched with individuals from a national mortality database to calculate their survival time.

RESULTS

Of all, 418 patients had renal function impairment (RFI) during their hospitalization. There were 209 (50%) patients with acute renal failure (ARF), and 110 (26.3%) patients with ESRD. The adjusted hazard ratios (HR) of ARF for 6-week and 1-year mortalities of cirrhotic patients with EVB were 4.90 (P<0.001) and 4.34 (P<0.001), compared to the non-RFI group. However, the adjusted HRs of ESRD for 6-week and 1-year mortalities were 1.19 (P=0.404) and 1.50 (P<0.001), compared to the non-RFI impairment group.

CONCLUSION

ESRD is associated with 1-year mortality, but not a risk factor for 6-week mortality in cirrhotic patients with EVB.