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Abstract: FR-PO751

Hospitalizations for Cryptococcal Meningitis in End-Stage Kidney Disease (ESKD) Patients Without HIV: National Estimates 2006-15

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Awan, Ahmed A., Baylor College of Medicine, Houston, Texas, United States
  • Anumudu, Samaya Javed, Baylor College of Medicine, Houston, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Walther, Carl P., Baylor College of Medicine, Houston, Texas, United States

While cryptococcal meningitis (CM) has been reported in HIV-negative persons with ESKD, its epidemiology is poorly described


Using the National Inpatient Sample, a national all-payer database, we estimated CM hospitalizations among persons with ESKD from 2006-15. Using ICD9 codes, we identified patients with ESKD on dialysis (CKD-G5D), and transplanted (CKD-T), CM (in first 5 discharge diagnoses, to improve specificity), and HIV. We evaluated in-hospital mortality in CKD-G5D and CKD-T patients without HIV using logistic regression models,adjusted for demographics and a priori comorbidities (age, sex, diabetes, liver disease, heart failure, lung disease, rheumatic disease).


We estimated 1855 hospitalizations of ESKD patients with non-HIV CM from 2006-15, with409 (95% CI:317-502) on dialysis, and 1446 (95% CI:1212-1680) with kidney transplant. The number of hospitalizations increased from 2006-2007 to 2008-2009 , especially in the CKD-T population, and has remained steady since then (Figure).In-hospital mortality was higher for patients with CKD-G5D compared to CKD-T:21% (95% CI 12.3-29.9%) vs. 9% (95% CI 2.0-16.0%), respectively. Adjusted odds -ratio for death in CKD-T vs.CKD-G5D was 0.39 (95% CI [0.16-0.96]).


ESKD patients without HIV are at risk for cryptococcal meningitis, and nephrologists should be aware of this risk. Mortality among those on dialysis is significantly higher than among those with a kidney transplant, perhaps reflecting underlying severe comorbidities causing the immune suppression among affected dialysis patients.