Impact of CKD/Kidney Failure on Angiodysplasia-Related Gastrointestinal Bleeding

Key Points First US national study showing angiodysplasia-related gastrointestinal bleeding incidence and readmissions rises progressively with worsening CKD stage. Patients with kidney failure were less likely to receive endoscopy, which was linked to higher mortality, revealing a potential care gap. Recurrent angiodysplasia-related gastrointestinal bleeding was the leading cause of 30-day readmission; lack of endoscopy was an independent predictor of readmission. Background Angiodysplasia-related gastrointestinal bleeding (AGIB) is an increasingly recognized cause of hospitalization, particularly among patients with CKD. Although AGIB has been linked to kidney failure (KF), its burden across CKD stages remains unclear. This study aimed to evaluate AGIB incidence, outcomes, and readmissions across CKD stages using the largest inpatient and readmission databases in the United States. Methods We conducted a retrospective cohort study using the 2022 National Inpatient Sample and Nationwide Readmissions Database. Adult patients hospitalized with AGIB were identified and stratified into five groups: non-CKD, early CKD (stage 3), advanced CKD (stages 4–5 not on dialysis), KF (ESKD requiring chronic dialysis), and others. The primary outcome was AGIB hospitalization incidence. Secondary outcomes included in-hospital mortality, disease severity, treatment interventions, health care utilization, and 30-day readmission. Multivariable regression models were used to identify independent risk. Results In 2022, 46,670 adults were hospitalized with AGIB (0.17% of all admissions). CKD/KF was an independent risk factor for AGIB hospitalization, with risk increasing progressively with worsening kidney function (adjusted odds ratio [aOR]: 1.42 [1.34 to 1.50; early CKD], 1.89 [1.72 to 2.07; advanced CKD], 2.51 [2.32 to 2.72; KF]; all P < 0.001). The overall in-hospital mortality rate was 1.04%, higher among patients with CKD. KF was independently associated with higher mortality (aOR, 1.87 [1.06 to 3.27]), lower rates of endoscopic evaluation (aOR, 0.53 [0.43 to 0.65]), and longer hospital stays. Endoscopy was associated with lower mortality (aOR, 0.54 [0.32 to 0.92]). The 30-day all-cause readmission rate was 22.3%, with recurrent AGIB as the leading cause. Readmission risk increased progressively with CKD stage. Conclusions CKD progression is strongly associated with increased risk of AGIB hospitalization and readmission. KF and lack of endoscopic evaluation were independent mortality risk factors. These findings highlight the need for proactive management strategies in this high-risk population.