Risk of Infective Endocarditis in Patients with End Stage Renal Disease

Clinical journal of the American Society of Nephrology: CJASN

Mavish S. Chaudry² 

[1] and..**Department of Cardiology and Clinical Epidemiology, Aalborg University Hospital and Department of Health Science and Technology, and..;*Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark;¶Division of Infectious Diseases and International Health, Department of Medicine, Duke University School of Medicine, Durham, North Carolina;‖Department of Nephrology, University Hospital Copenhagen Rigshospitalet, Copenhagen, Denmark;†The Danish Heart Foundation, Copenhagen, Denmark

关键词: hemodialysis;    peritoneal dialysis;    kidney transplantation;    vascular access;    dialysis access;    end stage kidney disease;    Endocarditis;    mortality;    Middle Aged;    renal dialysis;    Central Venous Catheters;    Incidence;    risk factors;    Aortic Valve;    Kidney Failure, Chronic;    RRT;    kidney;    Heart Defects, Congenital;    Heart Valve Diseases;    Registries;    Endocarditis;   

DOI  :  10.2215/CJN.02320317

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Endocarditis is a serious complication in patients treated with RRT. The study aimed to examine incidence and risk factors of endocarditis in patients with ESRD.Design, setting, participants, & measurements The Danish National Registry on Regular Dialysis and Transplantation contains data on all Danish patients receiving renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD. Incidence of endocarditis was estimated for each RRT modality. Independent risk factors of endocarditis were identified in multivariable Cox regression models.Results From January 1st, 1996 to December 31st, 2012, 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation). Endocarditis developed in 267 (2.5%); of these 31 (12%) underwent valve surgery. The overall incidence of endocarditis was 627 per 100,000 person-years in patients receiving RRT. Incidence was higher in patients receiving hemodialysis compared with those receiving peritoneal dialysis or kidney transplantation (1092 per 100,000 person-years, 212 per 100,000 person-years, and 85 per 100,000 person-years, respectively). Adjusted hazard ratios for endocarditis in patients receiving hemodialysis were 5.46 (95% confidence interval [95% CI], 3.28 to 9.10) and 0.41 (95% CI, 0.18 to 0.91) for kidney-transplanted recipients, respectively, as compared with patients in peritoneal dialysis. The incidence of endocarditis in hemodialysis recipients with central venous catheters was more than two-fold higher as compared with those with arteriovenous fistulas. Overall mortality, subsequent to endocarditis, was 22% in-hospital and 51% at 1 year. The first 6 months in RRT, aortic valve disease, and previous endocarditis were identified as significant risk factors of endocarditis.Conclusions Patients receiving RRT have a high incidence of endocarditis, in particular during hemodialysis treatment using central venous catheters. The first 6 months in RRT, aortic valve disease, and previous endocarditis are significant risk factors for developing endocarditis.

【 授权许可】

CC BY