Kidney Failure's Bleeding Risk

Kidney failure patients have high rates of gastrointestinal bleeding

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Kidney disease puts people at risk for a number of related health complications. As their kidneys start to fail, some patients may even bleed from their stomach or intestines, a problem that may need more attention.

The rate of upper gastrointestinal bleeding (bleeding in the esophagus, stomach, or first part of the intestine) among people with kidney failure is more than 10 times higher than that of the general population.

This is an issue that needs addressing, as upper gastrointestinal bleeding can lead to some serious health problems and early death for kidney failure patients.

"Talk to your doctor about kidney failure and gastrointestinal bleeding."

Upper gastrointestinal bleeding - and the risk of death that comes with it - has become less of a problem for the general population of the United States.

However, it is not known if rates of upper gastrointestinal bleeding have decreased similarly for those with kidney failure, explains Wolfgang Winkelmayer, M.D., Sc.D., from the Stanford University School of Medicine and co-author of the study.

"People develop renal failure for a variety of reasons, many of which independently cause higher risk of gut bleeds," explains Steven Kussin, M.D., FACP, a gastroenterology expert and founder of central New York's only Shared Decision Center. "Renal failure patients more often have a history of smoking and cardiovascular disease which are risk factors for digestive tract bleeding."

Gastrointestinal bleeding poses a threat to anyone, not just kidney disease patients. Sometimes, the bleeding is only slight, leading to less serious complications.

In other cases, however, there can be substantial bleeding, putting a person at risk of death or other serious problems such as anemia (loss of iron), hypovolemia (the heart's inability to pump enough blood), shock, dehydration, and chest pain.

"Dialysis patients are older than the general population and have a higher chance of having other diseases associated with mucosal disease and bleeding such as diverticulosis, cancer and a compromised blood supply to the gut," says Dr. Kussin, who was not involved in the study.

"Once patients with renal failure bleed, they are more at risk. Kidney failure may decrease platelet function, and many kidney patients are on antiplatelet agents. Those patients who are treated with hemodialysis are on anticoagulants. All these factors make the bleeding more severe than for those in the general population who suffer GI bleeding."

Through studying data from more than 948,000 patients in the US Renal Data System, Dr. Winkelmayer and his colleagues found that nearly 12 percent of kidney failure patients died within one month of upper gastrointestinal bleeding. Nonetheless, the mortality rate decreased by 2.3 to 2.8 percent per year.

While a decrease in mortality rates is good news, the rates of upper gastrointestinal bleeding among dialysis patients did not change much between 1998 and 2007. If anything, there may have been slight increases in the rate of gastrointestinal bleeding.

These findings suggest that a stronger effort may be needed to protect kidney patients from upper gastrointestinal bleeding.

Dr. Kussin recommends that kidney failure patients on dialysis ask their doctors about treatment for H. pylori, a type of stomach infection associated with ulcers.

"The use of [nonsteroidal anti-inflammatory drugs] is discouraged," he says. "The use of acid blockers should be considered and always started in those who have acid related symptoms."

By being aware of certain symptoms, kidney patients can do their part to protect themselves from bleeding. "Patients with kidney disease should report changes in the stool color or more profound weakness than usual," says Dr. Kussin, "as these may be findings of chronic blood loss and anemia."

According to the study's authors, the reduced risk of death related to gastrointestinal bleeding may be due to improvements in medical care. Still, upper gastrointestinal bleeding remains a significant problem for kidney disease patients on dialysis.

The full results of the study are published in the Journal of the American Society of Nephrology (JASN).

Reviewed by: 
Review Date: 
January 23, 2012
Last Updated:
January 27, 2012