Chronic Kidney Disease and Risk for Gastrointestinal Bleeding in the Community: The Atherosclerosis Risk in Communities (ARIC) Study.

BACKGROUND AND OBJECTIVES: Patients on dialysis are known to have higher risk for gastrointestinal (GI) bleeding. However, data on mild to moderate CKD, particularly elevated albuminuria, are limited.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 11,088 participants in the Atherosclerosis Risk in Communities (ARIC) Study, we investigated the association of eGFR and urinary albumin-to-creatinine ratio (ACR) with risk for hospitalization with GI bleeding. Kidney measures were assessed at visit four (1996-1998), and follow-up was continued through 2011.

RESULTS: During a median follow-up of 13.9 years, 686 first incident hospitalizations with GI bleeding were observed (incidence rate, 4.9 per 1000 person-years [95% confidence interval (95% CI), 4.5 to 5.3]). Multivariable Cox proportional hazards models revealed that both lower eGFR and higher ACR were associated with higher risk for GI bleeding. With eGFR≥90 ml/min per 1.73 m as a reference, risk for GI bleeding was significant in moderately decreased eGFR of 30-59 ml/min per 1.73 m (hazard ratio [HR], 1.51; 95% CI, 1.13 to 2.02), and was highest in severely decreased eGFR

CONCLUSIONS: Individuals with even mild to moderate CKD warrant clinical attention regarding the risk of hospitalization with GI bleeding.