Impact of End-Stage Renal Disease on Outcomes After Salvage Transcatheter Arterial Embolization for Duodenal Ulcer Bleeding.

OBJECTIVE: To evaluate whether end-stage renal disease (ESRD) is associated with clinical outcomes after salvage transcatheter arterial embolization for duodenal ulcer bleeding and to compare angiographic characteristics between patients with and without ESRD. METHODS: We conducted a two-center retrospective cohort study at Ganzhou Hospital-Nanfang Hospital, Southern Medical University (Ganzhou People's Hospital) and Ganzhou Cancer Hospital, including consecutive patients with duodenal ulcer bleeding who underwent salvage transcatheter arterial embolization after failed endoscopic hemostasis between January 2017 and November 2024. Patients were classified into ESRD and non-ESRD groups according to the presence or absence of a documented diagnosis of ESRD requiring maintenance dialysis before the bleeding event. The primary outcome was delayed rebleeding between days 8 and 90 after embolization. Secondary outcomes included initial hemostatic success, early rebleeding, and 90-day all-cause mortality. RESULTS: Among 65 patients, 17 (26.2%) had ESRD. Positive angiographic findings occurred less frequently in the ESRD group than in the non-ESRD group (29.4% vs 60.4%). Initial hemostatic success and early rebleeding rates were comparable between groups. Delayed rebleeding occurred in 5 of 17 patients with ESRD (29.4%), whereas no delayed rebleeding was observed among the 48 patients without ESRD. Ninety-day all-cause mortality was also higher in the ESRD group (47.1% VS 14.6%). CONCLUSION: In this two-center cohort, ESRD was associated with fewer positive angiographic findings, increased delayed rebleeding, and higher 90-day all-cause mortality after salvage embolization for duodenal ulcer bleeding following failed endoscopic hemostasis. These findings suggest that patients with ESRD may warrant closer post-embolization surveillance, although confirmation in larger studies is needed.