Early eradication has a lower risk of peptic ulcer bleeding in Helicobacter pylori-infected chronic kidney disease patients

  • Ching-Hui Hsu
    Division of Allergy, Immunology, Rheumatology, Taipei City Hospital Yang-Ming Branch, Taiwan

    Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan
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  • Hsiao-Yun Hu
    Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan

    Department of Education and Research, Taipei City Hospital, Taiwan
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  • Nicole Huang
    Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
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  • Shen-Shong Chang
    Corresponding author at: Division of Gastroenterology, Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, No 105, Yusheng Street, Shihlin District, Taipei 111 11217, Taiwan. Tel.: +886 2 28353456 6960; fax: +886 2 28389551.
    Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taiwan

    Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan

    School of Medicine, National Yang-Ming University, Taiwan

    Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan
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      • Early H. pylori eradication has a lower risk of PUB in CKD patients.
      • H. pylori eradication at Charlson's score more than 3 is a risk factor of PUB.
      • The incidence of PUB was higher in the ESRD cohort than in the pre-ESRD cohort.



      End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori (H. pylori) eradication therapy is necessary for H. pylori-infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage.

      Methods and patients

      Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB.


      We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB.


      Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori-infected CKD patients.


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