Pneumonia in incident dialysis patients--the United States Renal Data System

Abstract

Background: Although clinical experience suggests that pneumonia may occur frequently in dialysis patients, its clinical epidemiology in that group remains poorly defined.

Methods: 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.

Results: 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.

Conclusions: Common in dialysis patients, pneumonia is an antecedent association of cardiovascular disease and death.