Pneumonia in Incident Dialysis Patients – The United States Renal Data System

United States Renal Data System Coordinating Center, Minneapolis, MN 55404, USA.
Nephrology Dialysis Transplantation (Impact Factor: 3.58). 02/2008; 23(2):680-6. DOI: 10.1093/ndt/gfm474
Source: PubMed


Although clinical experience suggests that pneumonia may occur frequently in dialysis patients, its clinical epidemiology in that group remains poorly defined.
Medicare claims were used to identify pneumonia episodes in 289,210 patients initiating dialysis in the United States between 1996 and 2001 and followed until 31 December 2003.
Mean patient age was 63.8 years; 48.0% had diabetes and 9.6% used peritoneal dialysis as initial therapy. The overall incidence rate was 27.9/100 patient-years (29.0 in haemodialysis patients vs 18.2 in peritoneal dialysis patients, P < 0.0001) and remained relatively constant from year to year. On multivariate analysis, the primary associations of pneumonia [adjusted hazards ratio (AHR) > 1.25 or < 0.80, P < 0.0001] were chronic obstructive pulmonary disease (AHR 1.47), inability to transfer or ambulate (AHR 1.44), haemodialysis as initial therapy (AHR 1.41 vs peritoneal dialysis), age > or = 75 (AHR 1.40 vs 20-44 years), body mass index > or =30 kg/m(2) (AHR 0.77 vs 18.5-24.9 kg/m(2)) and age 0-19 years (AHR 0.61 vs 20-44 years). Survival probabilities after pneumonia were 0.51 at 1 year. Using interval Poisson regression analysis, AHRs were 4.99 (95% confidence interval 4.87-5.12) for death and 3.02 (2.89-3.16) for cardiovascular disease in the initial 6-month interval after pneumonia, declining to 2.12 (1.90-2.37) for death and 1.45 (1.12-1.87) for cardiovascular disease at 5 years.
Common in dialysis patients, pneumonia is an antecedent association of cardiovascular disease and death.

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    • "In our study, independent risk factors for mortality in CKD patients were older age and cardiac complications during hospitalization. These data are consistent with studies in which CKD patients had a higher risk of acute cardiovascular events and death following pneumonia and septicaemia[4,22,23]. Other reports have also found increased rates of acute cardiac events in patients with CAP[24,25]. "
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    ABSTRACT: Although infection remains among the most common causes of morbidity and mortality in patients with chronic kidney disease (CKD), data on epidemiology, clinical features and outcomes of pneumonia in this population are scarce. Observational analysis of a prospective cohort of hospitalized adults with pneumonia, between 13 February 1995 and 30 April 2010, in a tertiary teaching hospital. CKD patients, defined as patients with a baseline glomerular filtration rate <60 mL/min/1.73 m(2), were compared with non-CKD patients. During the study period, 3800 patients with pneumonia required hospitalization. Two-hundred and three (5.3%) patients had CKD, of whom 46 were on dialysis therapy. Patients with CKD were older (77 versus 70 years; P < 0.001), were more likely to have comorbidities (82.3 versus 63.3%; P < 0.001) and more commonly classified into high-risk pneumonia severity index classes (89.6 versus 57%; P < 0.001) than were the remaining patients. Streptococcus pneumoniae was the most frequent pathogen (28.1 versus 34.7%; P = 0.05). Mortality was higher in patients with CKD (15.8 versus 8.3%; P < 0.001). Among CKD patients, age [+1 year increase; adjusted odds ratio, 1.25; 95% confidence interval (CI) 1.07-1.46] and cardiac complications during hospitalization (adjusted odds ratio, 9.23; 95% CI 1.39-61.1) were found to be independent risk factors for mortality, whereas prior pneumococcal vaccination (adjusted odds ratio, 0.05; 95% CI 0.005-0.69) and leukocytosis at hospital admission (adjusted odds ratio, 0.10; 95% CI 0.01-0.64) were protective factors. Pneumonia is a serious complication in CKD patients. Independent factors for mortality are older age and cardiac complications, whereas prior pneumococcal vaccination and leucokytosis at hospital admission are protective factors. These findings should encourage physicians to increase pneumococcal vaccine coverage among CKD patients.
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