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Kidney Week

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

Authors

  • 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
Background

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

Methods

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).

Results

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]).

Conclusion

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.

Figure.