Are dialysis patients at an increased risk of GI bleed? is this the same for PD and Hemo patients

Ju-Yeh yang et al published this study at JASN; titled
"Trends in Acute Nonvariceal Upper Gastrointestinal
Bleeding in Dialysis Patients".
in this study the authors shed some light on why Hemodialysis patients have higher recurrence and 30-day mortality of acute Non-varecial upper Gi bleeding. it's an interesting approach from an epidemiologic point of view where they site Lenient and stringent definitions, and other ways of looking at outpatient management of GI bleed and including those to the total tally. however; they offer some added risk factors that Hemodialysis patients are especially exposed to which may explain the high recurrent and mortality of upper GI bleed that they face. these include; "

Advanced age, male sex, and certain medications (such as
antiplatelet or anticoagulant agents".
of note; they mention that some of the reported increased in GI Bleed in these patients may be due to vigilant coding of these occurrence Because of the added financial incentive of reporting GI bleed under the new billing system.
for the full text go to JASN . http://jasn.asnjournals.org/content/early/2012/01/18/ASN.2011070658.full.pdf+html]

TOPIC DISCUSSION: Wunderlich Syndrome

Wunderlich syndrome can be seen in dialysis patients.  It is spontaneous non traumatic renal hemorrhage.  Usually this is seen in angiomyolipomas and sometimes even in urothelial cell cancers. Some cancers are common in dialysis patients, renal cell or urothelial can be seen.  Usually the syndrome presents with back pain, flank pain or hip pain.  CT scan can diagnosis it. If they are not making urine, blood in the urine might not be noted.  A high index of suspicion in at-risk patients therefore is important to timely identify and manage this disease.

A recent AJKD article describes this entity.

Ref:

http://www.ncbi.nlm.nih.gov/pubmed/21684433

http://www.ncbi.nlm.nih.gov/pubmed/21566314