Nonsteroidal antiinflammatory drugs and risk of gastrointestinal bleeding among patients on hemodialysis

Both use of nonsteroidal antiinflammatory drugs (NSAIDs) and chronic renal insufficiency are significant independent risk factors for gastrointestinal bleeding. The aim of our study was to investigate whether regular use of NSAIDs further increases the risk of gastrointestinal bleeding among patients with end-stage renal insufficiency on hemodialysis. This was a case-control study. Case and control patients were selected from the lists of patients on hemodialysis during the period of 4 months (n=650), at 3 secondary care general hospitals in Serbia. Cases (n=33) were chosen from the study population if they had experienced at least 1 episode of gastrointestinal bleeding during the last 3 years. For each case, at least 1 sex- and age-matched control patient (n=45) was randomly selected from the source population. Among patients on hemodialysis, NSAIDs users had approximately 3 times higher risk of developing gastrointestinal bleeding, than non-users (crude odds ratio = 3.29; 95% confidence interval [95% CI], 1.28-8.45). After adjustment for potential confounders (sex, age, use of erythropoietin or parenteral iron, frequency of NSAID use, smoking, drinking alcohol, heart failure, arterial hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and use of anticoagulants, antiplatelet agents, beta-blockers, angiotensin-converting enzyme inhibitors or diuretics), the only significant association that remained was between gastrointestinal bleeding and use of NSAIDs (OR adjusted = 5.8; 95% CI, 1.3-26.9; p=0.024). There is a need for development of effective strategies to prevent gastrointestinal bleeding in patients on hemodialysis who use NSAIDs.