Upper Gastrointestinal Bleeding in Patients in Chronic Hemodialysis

Dear Sir, Upper gastrointestinal bleeding (UGH) is a frequent complication of advanced renal disease and is the cause of death in 3-7% of patients with moderate to severe renal disease [1]. Duodenal ulcers have been proposed as the major cause of UGH in patients with chronic renal disease [2, 3] although recently angiodysplasia of the stomach and duodenum has been reported as the most frequent source of bleeding in this population [4, 5]. Most series have studied patients with different degrees of chronic renal disease and few have focused exclusively on patients in chronic hemodialysis. We retrospectively reviewed (1980-1990) the inpatient records of 21 patients in chronic hemodialysis at our center who had an UGH and an upper gastrointestinal endoscopic procedure done during the first 24^18 h of the episode. All endoscopic procedures were done by one member of the gastroenterology section of the hospital (N.K.). An endoscopic lesion was thought to be responsible for the bleeding episode if the lesion was seen actively bleeding or had a fresh or adherent clot or if there was evidence of recent bleeding and the lesion seen was the only lesion that could explain the episode of bleeding. The patients were dialyzed regularly in 4-hour sessions 3 times/week using hollow-fiber dia-lyzers with acetate bath. These 21 patients had 34 episodes of UGH. The mean age of the patients was 54.5 ± 2.9 years (range 28-83); 14 were male (66.6%) and 7 were female (33.3%). The mean time from the beginning of dialysis to the first episode of UGH was 34.2 ± 7.8 months (range 3-128). The predisposing factors for UGH were: a history of recent major physical stress (surgery, trauma or septicemia) in 6 patients, ulcerogenic medication in 5, bleedTable 1. Sources of UGH Source Patients