Abstract: TH-PO897

Incidence, Risk Factors, and Distribution of Syphilis in the ESRD Population in the United States

Session Information

  • Dialysis: Infection
    November 02, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 610 Dialysis: Infection

Authors

  • Weathers, Erena, Augusta University, Augusta, Georgia, United States
  • Waller, Jennifer L., Augusta University, Augusta, Georgia, United States
  • Nahman, N. Stanley, Augusta University, Augusta, Georgia, United States
  • Colombo, Rhonda E., Augusta University, Augusta, Georgia, United States
  • Turrentine, Jake Everett, Augusta University, Augusta, Georgia, United States
  • Kheda, Mufaddal F., Augusta University, Augusta, Georgia, United States
  • Baer, Stephanie L, Augusta VA Medical Center, Augusta, Georgia, United States
Background

The incidence of syphilis has increased 67% in 4 years to 7.5 per 100,000 in the US, but is undefined in the end stage renal disease (ESRD) population. This study examined diagnoses of syphilis and associated risk factors in ESRD patients to identify opportunities for improving screening and risk modification.

Methods

All incident ESRD patients from 2004-2010 in the USRDS were queried. ICD-9 codes were used to determine syphilis diagnosis and related comorbidities. Neurosyphilis (NS) was defined with both an ICD-9 code and an associated lumbar puncture CPT code. The geographical distribution was determined by number of cases per 100,000 ESRD patients in each state. A 5% random sample of patients without syphilis was used for analysis. Statistical analysis was performed using SAS 9.4 and a generalized linear model was used to examine the adjusted relative risk (aRR).

Results

Of 773,600 patients, 585,072 had complete data for analysis. 383 diagnoses of syphilis were identified. The incidence of syphilis diagnosis increased yearly from 2004-2011, with a peak incidence in 2011 of 54 per 100,000. The syphilis diagnoses were: 59% other unspecified, 22% NS and other types 1% or less. Associated risk factors included: hepatitis B (aRR=1.75 95% confidence interval (CI) 1.12-2.71), hepatitis C (aRR=3.60 95% CI 1.99-6.51), herpes simplex virus (aRR=2.05 95% CI 1.46-2.87), and HIV (aRR=7.55 95% CI 5.42-10.52). Demographic risk factors included black (aRR=4.96 95% CI 3.85-6.40) and other (non-white) race (aRR=1.99 95% CI 1.14-3.47). The highest rates were in the southeast followed by the northeast and west coast.

Conclusion

In the ESRD population, the incidence of syphilis was over 3 fold greater than in the general population in 2011, with the majority coded as unspecified syphilis followed by NS. The trend of rising incidence from 2004-2011, associated risk factors, and the geographic spread of syphilis in ESRD reflects the general population. These data suggest that routine screening for syphilis in the ESRD population may be beneficial.