Risk of death after first-time blood stream infection in incident dialysis patients with specific consideration on vascular access and comorbidity

• Published in: BMC infectious diseases 2018-12, Vol.18 (1), p.688-688, Article 688
• Main Authors: Nelveg-Kristensen, Karl Emil, Laier, Gunnar Hellmund, Heaf, James Goya
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - mortality; Blood; Blood stream infection; Care and treatment; Catheter-Related Infections - blood; Catheter-Related Infections - epidemiology; Catheter-Related Infections - microbiology; Catheter-Related Infections - mortality; Catheters; Cause of Death; Central Venous Catheters - microbiology; Central Venous Catheters - statistics & numerical data; Chronic kidney failure; Comorbidity; Complications and side effects; Death; Diagnosis; Dialysis; Dialysis modality; Female; Health aspects; Health risk assessment; Health risks; Hemodialysis; Hemodialysis patients; Humans; Incidence; Infections; Infectious diseases; Male; Middle Aged; Mortality; Patient outcomes; Patients; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - mortality; Peritoneal Dialysis - statistics & numerical data; Peritoneum; Renal Dialysis - adverse effects; Renal Dialysis - methods; Renal Dialysis - mortality; Renal Dialysis - statistics & numerical data; Retrospective Studies; Risk analysis; Risk Factors; Studies; Time dependence; Vascular access; Venous access; Young Adult
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-018-3594-7

The mortality following blood stream infection (BSI) and risk of subsequent BSI in relation to dialysis modality, vascular access, and other potential risk factors has received relatively little attention. Consequently, we assessed these matters in a retrospective cohort study, by use of the Danish nation-wide registries. Patients more than 17 years of age, who initiated dialysis between 1.1.2010 and 1.1.2014, were grouped according to their dialysis modality and vascular access. Survival was modeled in time-dependent Cox proportional hazard analyses. Potential risk factors confined by a modified Charlson comorbidity index (MCCI), were subsequently assessed in stepwise selection models. At baseline, 764 patients received peritoneal dialysis (PD), and 434, 479, and 782 hemodialysis (HD) patients were dialyzed by use of arteriovenous fistulas (AVFs), tunneled catheters (TCs), and non-tunneled catheters (NTCs), respectively. We identified 1069 BSIs with an overall incidence rate of 17.7 episodes per 100 person years, and 216 BSIs occurred more than one time in the same patient. HRs of post BSI mortality relative to PD were 3.20 (95% CI 1.86-5.50; p