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Kidney Week

Abstract: PO1082

Frequency, Risks, and Outcomes of Sepsis Hospitalizations in the ESKD Population in the United States

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Merchant, Paul T., Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Shah, Silvi, Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Christianson, Annette, Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Leonard, Anthony C., Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Meganathan, Karthikeyan, Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Harrison, Kathleen, Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Kramer, Samantha M., Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
  • Thakar, Charuhas V., Division of Nephrology, University of Cincinnati, Cincinnati, Ohio, United States
Background

Although a biologically plausible link between End Stage Kidney Disease (ESKD) and sepsis exists, little is known about frequency, risk factors, and outcomes of sepsis-related hospitalizations in ESKD patients.

Methods

Of a retrospective cohort of 1,123,731 incident ESKD patients on dialysis (2005 to 2014) from the United States Renal Data System (USRDS), we studied the 508,372 with linked Medicare claims at initiation of dialysis and complete demographic data. Hospitalization data were obtained from Medicare claims with a sepsis hospitalization being identified by previously validated ICD-9 codes. Using Cox proportional hazard models, we examined the risk factors associated with a sepsis hospitalization and effect of a sepsis hospitalization on mortality.

Results

The study cohort was 55% male, 62% white, and had an average age of 70 years. A sepsis hospitalization occurred in 20.8% of the cohort. The overall rate of sepsis hospitalizations was 15.4 per hundred patient years (PHPY), and the trend increased over time from 13.8 PHPY in 2005 to a peak of 16.7 PHPY in 2011. Factors associated with higher likelihood of a sepsis hospitalization included female sex (Hazard Ratio [HR] 1.05, 95% CI 1.03-1.06), age >80 (vs. age <40; HR 1.30, 95% CI 1.24-1.36), dialysis access via catheter (vs. fistula/graft; HR 1.61, 95% CI 1.58-1.63), congestive heart failure (HR 1.28, 95% CI 1.26-1.30), and diabetes mellitus (HR 1.14, 95% CI 1.12-1.16). Compared to white race, minority races had lower likelihood of developing a sepsis hospitalization (Black HR 0.89, 95% CI 0.87-0.90; Hispanic HR 0.82, 95% CI 0.80-0.84; Asian HR 0.79, 95% CI 0.76-0.82; Native American HR 0.80, 95% CI 0.75-0.86). Compared to no hospitalizations, ESKD patients had a twofold increase in mortality following a first non-sepsis hospitalization (HR 2.14; 95% CI 2.12 to 2.16), increasing to ninefold over baseline following a sepsis hospitalization (HR 9.00; 95% CI 8.87-9.13).

Conclusion

Sepsis hospitalizations are frequent and are associated with significant mortality in ESKD patients in the U.S. Further studies need to focus on modifiable risk factors of sepsis and explore optimal therapies for sepsis in ESKD subjects.

Funding

  • Clinical Revenue Support