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. 2014 May 23;2(2):E109-14.
doi: 10.9778/cmajo.20120027. eCollection 2014 Apr.

Trends in infection-related hospital admissions and impact of length of time on dialysis among patients on long-term dialysis: a retrospective cohort study

Jean-Philippe Lafrance  1 , Elham Rahme  2 , Sameena Iqbal  3 , Naoual Elftouh  4 , Louis-Philippe Laurin  5 , Michel Vallée  6
Affiliations

Trends in infection-related hospital admissions and impact of length of time on dialysis among patients on long-term dialysis: a retrospective cohort study

Jean-Philippe Lafrance et al. CMAJ Open. .

Abstract

Background: After cardiovascular disease, infection is the second leading reason for admission to hospital among patients receiving long-term dialysis. We examined whether duration of dialysis treatment influences the rate of infection-related admission to hospital.

Methods: Using provincial administrative databases for Quebec, we built a retrospective cohort of all adults receiving long-term dialysis (hemodialysis or peritoneal dialysis) between 2001 and 2007. We evaluated rates of infection-related admission to hospital according to length of time on dialysis.

Results: A cohort of 9822 patients (mean age 66.3 [standard deviation ± 14.7] yr; 39.7% female) were followed for a median of 2.1 (range 1.0-3.9) years. Between 2001 and 2007, infection-related hospital admissions remained stable (from 0.20 to 0.19 per person-year; p = 0.7). All-cause hospital admission rates decreased by 22.9% (from 1.53 to 1.18 per person-year; p < 0.001), and cardiovascular-related admission rates decreased by 46.7% (from 0.45 to 0.24 per person-year; p < 0.001). The rate of infection-related admission remained stable with increasing time on dialysis (p = 0.1); however, both all-cause and cardiovascular-related admission rates decreased with length of time on dialysis (p < 0.001). Standardization of hospital admission rates by age, sex or length of time on dialysis did not change trends.

Interpretation: We found a stable rate of infection-related hospital admission between 2001 and 2007 among patients on long-term dialysis, independent of age, sex and length of time on dialysis. A decrease in all-cause and cardiovascular-related admission rates during the same period meant that the proportion of admissions related to infection increased. Because admissions to hospital are potentially preventable, understanding the epidemiology of infection-related admissions may inform future studies on prevention of this serious outcome.

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Conflict of interest statement

Competing interests:None declared.

Figures

Figure 1:
Figure 1:
Selection of study cohort. *Because of death or because dialysis started less than 90 days from the end of the study period.
Figure 2:
Figure 2:
Unadjusted rates of admission to hospital among patients on dialysis, 2001–2007. Error bars = 95% confidence intervals.
Figure 3:
Figure 3:
Unadjusted rates of admission to hospital among patients on dialysis, by length of time on dialysis. Error bars = 95% confidence intervals.
See this image and copyright information in PMC

References

    1. US Renal Data System. USRDS 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda (MD): National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.
    1. Quinn MP, Cardwell CR, Rainey A, et al. Patterns of hospitalisation before and following initiation of haemodialysis: a 5 year single centre study. Postgrad Med J 2011;87:389-93 - PubMed
    1. Chavers BM, Solid CA, Gilbertson DT, et al. Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States. J Am Soc Nephrol 2007;18:952-9 - PubMed
    1. Rayner HC, Pisoni RL, Bommer J, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19:108-20 - PubMed
    1. Allon M, Depner TA, Radeva M, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol 2003;14:1863-70 - PubMed

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