Thirty-Day Readmissions After Nonvariceal Upper Gastrointestinal Bleeding in CKD: A National Analysis

Background: National data on 30-day readmissions after non-variceal upper gastrointestinal bleeding (NVUGIB) in patients with chronic kidney disease (CKD) are limited. We aimed to evaluate 30-day readmission rates after NVUGIB and associated outcomes across CKD stages compared to patients without CKD (NCKD). Methods: Using the 2022 Nationwide Readmissions Database, we identified adults hospitalized for NVUGIB and discharged alive. Patients were categorized as NCKD, early CKD (ECKD; stage 3), advanced CKD (ACKD; stages 4 or 5), or ESKD. The primary outcome was 30-day all-cause readmission. Secondary outcomes included 30-day NVUGIB-specific readmission, causes for readmission, mortality during readmission, use of mechanical ventilation or vasopressors, length of stay, and hospital charges. Independent predictors of readmission were identified using Cox regression. Results: Among 207,817 index NVUGIB hospitalizations, the overall 30-day hospital readmission rate was 16.2%, increasing with CKD severity: 14.0 % in NCKD, 19.3% in ECKD, 23.8% in ACKD, and 30.4 % in ESKD. Recurrent NVUGIB accounted for 28% of readmissions. The 30-day NVUGIB-specific readmission rate was 3.2%, increasing with CKD severity: 2.9% in NCKD, 3.4% in ECKD, 4.1% in ACKD, and 6.3% in ESKD. Leading causes of readmission varied by group, with heart failure most common in CKD and sepsis in NCKD. Mortality during readmission (5.6%) was more than double that of the index hospitalization (2.1%) and increased with advancing CKD. Use of mechanical ventilation and vasopressors was more frequent during readmissions across all groups. Length of stay and hospital charges were also significantly higher. Overall, readmissions accounted for over 211,000 hospital days and $2 billion in costs. Independent predictors of readmission included ECKD, ACKD, ESKD, coagulopathy, anticoagulant use, longer initial hospitalization stay, and absence of endoscopic evaluation. Conclusion: Sixteen percent of patients hospitalized for NVUGIB were readmitted within 30 days, mostly for non-bleeding causes. Readmissions were associated with worse outcomes and greater resource use. The risk of readmission increased with CKD severity, underscoring the need for targeted strategies to reduce preventable readmissions in this high-risk population.