Molecular Prevalence and Risk Factors of Gastroesophageal Reflux Disease in Hemodialysis Patients

Background: The association between gastroesophageal reflux disease (GERD) and hemodialysis (HD) is unclear. We aimed to determine the prevalence of GERD in HD patients and to identify the risk factors and effects of GERD in this patient population. Methods: This retrospective study involved 432 HD patients who completed a questionnaire including a GERD symptom assessment scale (QUEST). Clinical data were obtained by interviewing the patients and/or reviewing their medical records. Results: GERD was diagnosed in 141 (32.64%) of the 432 HD patients by using a structured questionnaire scoring system. Multivariate logistic regression analysis revealed that low urine volume (odds ratio [OR]: 1.619, 95% confidence interval [CI]: 1.046–2.505; P = 0.031), high serum creatinine level (OR: 1.694, 95% CI: 1.011–2.839; P = 0.045), angiotensin receptor blocker (ARB)/angiotensin-converting enzyme inhibitor (ACEI) administration (OR: 1.767, 95% CI: 1.13–2.746; P = 0.011) and the intradialytic complications of excessive hunger (OR: 1.652, 95% CI: 1.067–2.559; P = 0.024), heartburn (OR: 6.235, 95% CI: 2.606–14.920; P = 0.000) and tinnitus (OR: 1.606, 95% CI: 1.029–2.507; P = 0.037) were independent predictors of GERD, as detected using QUEST. The Spearman rank correlation analysis showed that sodium bicarbonate consumption was positively correlated with serum total carbon dioxide level (r = 0.127, P = 0.008), interdialytic weight gain (IDWG; r = 0.189, P = 0.000) and IDWG% (IDWG/estimated dry weight; r = 0.166, P = 0.001). Conclusions: The prevalence of GERD is higher in patients undergoing HD in our center than in the general population. The risk factors for GERD in hemodialysis patients were low urine volume (<0.1 l/d), high serum creatinine level (>9 mg/dl), ARB/ACEI administration and intradialytic hunger, heartburn and tinnitus. HD patients with GERD may take excessive sodium bicarbonate, which increases IDWG%. Awareness of GERD and administration of PPIs were low in HD patients. Routine PPI treatment would provide clinical benefits by reducing GERD symptoms, sodium bicarbonate consumption and IDWG%.