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. 2016 Feb;31(2):315-23.
doi: 10.1007/s00467-015-3209-0.

Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age

Danilo Lofaro, Judith L Vogelzang, Karlijn J van Stralen, Kitty J Jager, Jaap W Groothoff

Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age

Danilo Lofaro et al. Pediatr Nephrol. 2016 Feb.

Abstract

Background: Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT.

Methods: The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and 1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over noninfectious HAR ratio (HARR).

Results: The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001).

Conclusions: Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.

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Figures

Fig. 1
Fig. 1
Flow chart of the study cohort. Registry of patients on renal replacement therapy (RENINE), Late Effects of Renal Insufficiency Cohort (LERIC)
Fig. 2
Fig. 2
Hospital admission incidence rate for infection and non-infection-related causes by decade and renal replacement therapy (RRT) modality. Inside the bars hospital admission incidence rates with 95 % confidence interval (CI) are presented. HD hemodialysis, PD peritoneal dialysis, TX transplantation
Fig. 3
Fig. 3
Hospital admissions incidence rate for infection in the first year and later after renal transplantation. Error bars represent 95 % CI
Fig. 4
Fig. 4
Infection/non-infection Hospital Admission Rate Ratio (HARR) according to decade and RRT modality. *p <0.001 vs the decade 2000–2010. Whiskers represent 95 % CI. HD hemodialysis, PD peritoneal dialysis, TX transplantation
Fig. 5
Fig. 5
Hospital Admission Rate (HAR) for the most frequent type of infections according to renal replacement therapy (RRT) modality. a Hemodialysis; b peritoneal dialysis; c renal transplantation. Error bars represent 95 % CI
See this image and copyright information in PMC

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