Hospitalizations for bacterial septicemia in patients with end stage renal disease due to diabetes on the renal transplant waiting list

Abstract

The incidence and risk factors for hospitalizations for bacterial septicemia, a serious cause of morbidity and mortality in end stage renal disease (ESRD), have been studied separately for patients on chronic dialysis and after renal transplantation, but have not been compared directly. Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994-30 June 1997. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for time to hospitalization for bacterial septicemia (ICD9 Code 038.x). In Cox Regression analysis, renal transplantation was independently associated with a shorter time to bacterial septicemia (HR 1.22, 95% confidence interval, 1.05-1.40). In addition, renal transplantation was associated with a higher rate of sepsis due to gram-negative organisms (HR 3.32, 95% CI 2.614.23) and urinary tract infection (10.43, 95% CI 6.72-16.17) compared with patients still on the renal transplant waiting list. The relative risk of sepsis increased with time after renal transplantation. Renal transplantation was associated with a significantly higher risk and different spectrum of bacterial septicemia than maintenance dialysis, and the risk of sepsis did not decrease over time.