P0591 - Risk Stratification of Gastrointestinal Bleeding in Patients With End Stage Renal Disease and Aortic Stenosis: A Single Center Retrospective Cohort Study

Avleen Kaur, MBBS¹, Syed M. Kodilinye, MBBS², Taif Al-Mansouri, MD¹, Kundan Jana, MBBS¹, Michael Silver, MS¹, Tin Mee Mee Aung, MBBS¹, Anthony Kalloo, MD, FACG^1
1Maimonides Medical Center, Brooklyn, NY; ²Maimonides Medical Center, New York, NY

Introduction: Angiodysplasias have been described as the most common cause of gastrointestinal bleeding (GIB) in hemodialysis patients. Similarly, aortic stenosis (AS) has been reported to be associated with GIB and has been termed as Heyde’s syndrome. We aim to study if aortic stenosis was associated with increased mortality in patients with End Stage Renal Disease(ESRD).

Methods: We obtained data from an inpatient database at Maimonides Medical Center from 2016-2022. Of these 189 ESRD patients, 78 had GIB and 111 were without GIB . The most common reason for endoscopy in non-gastrointestinal group was anemia. The baseline characteristics included patient demographics (age, race, and sex), relevant comorbidities. We further analyzed whether presence of ESRD and AS is associated with higher mortality and angiodysplasias as compared to patients without AS. All numeric variables were summarized with median and IQR, and compared across groups using a Mann-Whitney U Test. All factors were summarized with frequency and percentage and compared across groups using a chi-square test, or fisher exact test. Significant factors from table 1 were included in univariable and multivariable logistic regression models, with GIB as the outcome.



Results: A total of 189 patients were analyzed. Majority of patients (n=164) were on hemodialysis. Of these 78 had GIB and 111 were without GIB. Comparison of baseline characteristics of ESRD patients with and without GIB is summarized in Table 1. In the univariate regression analysis, only peptic ulcer disease was statistically significant risk factor for GIB. However, no differences in mortality and angiodysplasia were found in patients with ESRD with aortic stenosis (n=21) as compared to the ones without aortic stenosis (n=144) Table 1.

Discussion: GIB is a major cause of morbidity and mortality in hospital admissions. Multiple causes have been implicated in the increased incidence of GIB in hemodialysis patients including platelet dysfunction due to uremia, anti-platelet medication, angiodysplasias and erosive ulcers in upper GI tract. The pathophysiology for increased risk of GIB in both ESRD and AS has been linked to acquired von willebrand factor deficiency. In conclusion, peptic ulcer disease and not angiodysplasia is the major cause of bleeding in patients with ESRD.



Disclosures:


Avleen Kaur, MBBS¹, Syed M. Kodilinye, MBBS², Taif Al-Mansouri, MD¹, Kundan Jana, MBBS¹, Michael Silver, MS¹, Tin Mee Mee Aung, MBBS¹, Anthony Kalloo, MD, FACG¹. P0591 - Risk Stratification of Gastrointestinal Bleeding in Patients With End Stage Renal Disease and Aortic Stenosis: A Single Center Retrospective Cohort Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.