Patients with chronic kidney disease (CKD) are at increased risk of gastrointestinal complications, including hemorrhage, which can be life-threatening. The aim of this study was to evaluate the epidemiological characteristics and lesion profile of upper gastrointestinal bleeding (UGIB) in patients with CKD.

Objective

To describe the epidemiological, clinical, endoscopic, and outcome characteristics of upper gastrointestinal bleeding in patients with chronic kidney disease.

We conducted a single-center, prospective, descriptive study including all CKD patients admitted with upper gastrointestinal bleeding to the Emergency Department of Bab El Oued University Hospital between January 2023 and August 2025. All patients underwent upper gastrointestinal endoscopy.

For each patient, demographic data, type of bleeding presentation, hemodynamic status, laboratory findings, Glasgow-Blatchford score, endoscopic findings, management, and clinical outcomes were recorded.

Data entry and analysis were performed using SPSS version 23.0.

Among 281 patients admitted for UGIB, 49 had chronic kidney disease (17%). The mean age was 69 ± 14 years, with a sex ratio of 1.04.

Past medical history included portal hypertension (7.5%), ischemic heart disease (42.9%), heart failure (30.6%), and diabetes (44.9%).

Anticoagulants were used by 36.8% of patients and antiplatelet agents by 28.6%. Melena was the most common presenting symptom (57.1%), followed by hematemesis (34.7%) and massive hematochezia (8.2%). The mean Glasgow-Blatchford score was 13.4 ± 3.24.

Endoscopy showed recent signs of bleeding in 41.5% of cases. The etiologies of UGIB were as follows:

Gastroduodenal ulcers: 40%

Ulcerated esophagitis: 17.5%

Erosive gastritis: 7.5%

Angiodysplasia: 7.5%

Variceal bleeding: 9.5%

Neoplasia: 7.5%

No upper gastrointestinal cause was identified in 18.4% of patients. A colonoscopy was performed in 16.3% and revealed colonic angiodysplasia in 12.2%.

Blood transfusion was required in 75.5% of cases. Endoscopic therapy was performed in 18.4%: 14.3% received argon plasma coagulation, 7.1% underwent variceal ligation, and 2.4% received gastric variceal glue injection. Surgery was required in 2.4% of patients. Rebleeding occurred in 4.8%, and in-hospital mortality was 2.4%.

In our series, upper gastrointestinal bleeding in CKD patients predominantly affected elderly individuals. Gastroduodenal ulcers and digestive angiodysplasia were the most common etiologies.