Abstract: SA-PO997
Pre-ESRD Infection Event and Post-ESRD Mortality in Patients with Advanced CKD Transitioning to Dialysis
Session Information
- Hemodialysis and Frequent Dialysis - V
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Lee, Cheng chia, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Chang, Chih-Hsiang, Chang Gung Memorial Hospital, Taoyuan, Taiwan
Background
Accumulating evidence indicates that infection is a frequent event in patients with non-dialysis advanced chroinc kidney disease (CKD) and that reduced estimated glomerular filtration rate(eGFR) is associated with a higher risk of subsequent short-term mortality. However, It remains unclear whether infection events before entering dialysis have a long-term negative impact on patients with advanced CKD who survive to permanent dialysis.
Methods
Using Taiwan National Health Insurance Research Database, we enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis between January 1, 2004 and December 31, 2013. We identified 20,566 (32.7%) patients who had at least one infection episode during the pre-dialysis advanced CKD period. We used multivariable Cox models to determine the association of pre-dialysis infection exposure with all-cause mortality after starting dialysis. Furthermore, we analyzed the risk of post-ESRD mortality according to four quartiles based on the annual number of infection episodes during pre-dialysis advanced CKD.
Results
Compared with no infection during advanced CKD, the presence of infection exposure during that period was independently associated with a higher risk of first-year mortality (hazard ratio [HR] 1.42, 95% confidence interval [CI] 1.35–1.50) and the increased risk still exits during entire follow-up period (HR 1.22, 95% CI 1.19–1.25). The risks also increased incrementally with higher annual number of infections during advanced CKD (P for trend< 0.001).
Conclusion
Pre-ESRD infection events are associated with increased risk of ealy and late post-ESRD moratlity in patients with advanced CKD transitioning to dialysis.
All-cause mortality in patients with and without infection history during pre-dialysis advanced CKD
| No. of events (%) | Infection vs. non-infection | ||||||
| All | Infection | Non-infection | Univariate | Multivariate | |||
| All-cause mortality | (n = 62872) | (n = 20,566) | (n = 42,306) | HR (95% CI) | P value | HR (95% CI) | P value |
| 1-year follow-up | 5,637 (9.0) | 2,681 (13.0) | 2,956 (7.0) | 1.94 (1.84, 2.04) | <0.001 | 1.42 (1.35, 1.50) | <0.001 |
| At the end of follow-up | 25,475 (40.5) | 9,556 (46.5) | 15,919 (37.6) | 1.49 (1.46, 1.53) | <0.001 | 1.22 (1.19, 1.25) | <0.001 |
CI, confidence interval; CKD, chronic kidney disease; HR, hazard ratio;
Funding
- Private Foundation Support