Trends in the incidence of intestinal perforation in US dialysis patients (1992-2005)
Resource
J. Nephrol., 26(2), 281-288
Journal
Journal of Nephrology
Pages
281-288
Date Issued
2013
Date
2013
Author(s)
Yang J.-Y.
TSUNG-CHUN LEE
Montez-Rath M.E.
Desai M.
Winkelmayer W.C.
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.
Subjects
Adverse events
Dialysis
Gastrointestinal
Health services research
Safety
Phosphate binders
SDGs
Other Subjects
sevelamer; adult; aged; article; cohort analysis; comorbidity; controlled study; drug approval; drug exposure; female; hemodialysis patient; human; ICD-9-CM; incidence; intestine perforation; kidney disease; major clinical study; male; mortality; population research; risk factor; time series analysis; trend study; United States; Adult; Aged; Chelating Agents; Female; Humans; Incidence; Intestinal Perforation; Male; Medicare; Middle Aged; Polyamines; Prognosis; Renal Dialysis; Risk Assessment; Risk Factors; Time Factors; United States
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