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  • Editor in Chief: Prof. Giovanni Gambaro
  • Co-Editor: Benedetta Bussolati
  • Current issue: Vol. 26 issue Suppl. 22 , 2013 (November-December)

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Vol. 26 - Issue 2 (March-April 2013)

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)

J Nephrol 2013; 26(2): 281 - 288

Article Type: ORIGINAL ARTICLE

DOI:10.5301/jn.5000104

Authors

Ju-Yeh Yang, Tsung-Chun Lee, Maria E. Montez-Rath, Manisha Desai, Wolfgang C. Winkelmayer­

Abstract

Background: Little is known about the incidence of intestinal perforation in patients undergoing dialysis. Concerns exist that sevelamer hydrochloride may increase the risk of intestinal perforation. We examined long-term trends for the incidence of intestinal perforation among US dialysis patients. Methods: We studied all dialysis patients (1992-2005) who had Medicare as primary payer. We used ICD-9 diagnosis code 569.83 to ascertain events of intestinal perforation. We studied (a) all perforations and (b) perforations that did not appear to be associated with specific causative conditions (specific diseases or iatrogenic procedures within 7 days of perforation). We used Poisson regression to model the annual number of intestinal perforations and tested for any changes in levels and temporal trends of incidence rates before versus after January 1, 1999. Results: Overall, 1,060,132 patients contributed 2.7 million patient-years. We observed 12,355 events of intestinal perforation and 7,814 spontaneous perforations. The corresponding incidence rates were 4.6 (total) and 2.9 (spontaneous perforation) episodes per 1,000 person-years, respectively. For both outcome definitions, 30-day mortality was 42%. Unadjusted and adjusted incidence rates were not materially different over time. Formal tests for any changes in the level or slope of incidence comparing time periods before and after January 1, 1999, indicated no evidence for any changes in the incidence of intestinal perforation over time. Conclusions: In US dialysis patients, incidence of intestinal perforation was low, but associated with high short-term mortality. We did not detect any significant changes in the incidence of intestinal perforation before versus after approval of sevelamer hydrochloride in late 1998.

Article History

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Authors

  • Yang, Ju-Yeh [PubMed] [Google Scholar]
    Division of Nephrology, Stanford University School of Medicine, Palo Alto, California - USA; and Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City - Taiwan
  • Lee, Tsung-Chun [PubMed] [Google Scholar]
    Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei - Taiwan
  • Montez-Rath, Maria E. [PubMed] [Google Scholar]
    Division of Nephrology, Stanford University School of Medicine, Palo Alto, California - USA
  • Desai, Manisha [PubMed] [Google Scholar]
    Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California - USA
  • Winkelmayer­, Wolfgang C. [PubMed] [Google Scholar]
    Division of Nephrology, Stanford University School of Medicine, Palo Alto, California - USA

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