Gastrointestinal hemorrhage in hemodialysis patients.

INTRODUCTION: Gastrointestinal bleedings are frequently dramatic events. So far hardly any data concerning the frequency of such bleedings in patients treated with chronic hemodialysis are available. Thus, the objective of this study is to collect data about the incidence of such events in a dialysis center. MATERIALS AND METHODS: Data of a total of 65 patients who had been treated in the dialysis center between January 01, 2000 and February 28, 2007, including all episodes of gastrointestinal bleedings, have been collected and a correlation with the duration of treatment with hemodialysis has been established. Afterwards we differentiated between those patients who additionally were treated with anticoagulants and those who were not. RESULTS: In a total of 3195 months of treatment, 11 gastrointestinal bleedings were observed. In patients who underwent anticoagulation therapy the risk of experiencing gastrointestinal bleeding was approximately 3 times higher (one episode of bleeding in 16 years) than in the other patients (one episode of bleeding in 46.2 years). DISCUSSION: Compared to the general population, the incidence of gastrointestinal bleeding is increased in hemodialysis patients. Treatment with anticoagulants leads to an even higher risk. Consequently, with regard to concomitant medication which might contribute to increasing the risk of gastrointestinal bleeding, the necessity and therapeutic benefits of the treatment have to be carefully weighed against the potential risks that it might carry for the individual patient.

Continuous ambulatory peritoneal dialysis--developments during changing times.

INTRODUCTION: Continuous ambulatory peritoneal dialysis (CAPD) treatment is subject to constant changes. Departing from this thesis, it should be analyzed in which respects CAPD treatment at the Heidelberg outpatient clinic has changed when considering demographic data, and CAPD-specific data including infection rates and clinical parameters. MATERIALS AND METHODS: A retrospective study was carried out in the course of which a cohort of 67 CAPD patients treated before the year 2000 was compared with a cohort of 53 patients treated from the year 2000 on. Demographic data, CAPD-specific and clinical data at the commencement of treatment and data gathered during the observation period thereafter were recorded. RESULTS: The patients of the more recent cohort were 5 years older. At the initiation of treatment, the volume of residual diuresis was higher in the patients treated from 2000 on than in those treated before. The blood pressure in patients belonging to the more recently treated group was also lower than the blood pressure of those treated before. The incidence of peritonitis and exit-site infections has decreased. On the other hand, the hemoglobin level has risen. DISCUSSION: Compared to the past, many parameters have improved. Above all, the findings suggest that medical care and treatment have become better, probably as a result of the modified guidelines. The significant decrease in infections is probably also due to the use of the new dialysis fluids.