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Abstract: SA-PO718

Bacterial Infections in Patients With ESKD due to Glomerular Disease in the United States

Session Information

Category: Glomerular Diseases

  • 1303 Glomerular Diseases: Clinical‚ Outcomes‚ and Trials

Authors

  • Charu, Vivek, Stanford University School of Medicine, Stanford, California, United States
  • Han, Jialin, Stanford University School of Medicine, Stanford, California, United States
  • Montez-Rath, Maria E., Stanford University School of Medicine, Stanford, California, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • O'Shaughnessy, Michelle M., University College Cork, Cork, Cork, Ireland
Background

Patients with kidney failure on dialysis are at increased risk for infection. However, whether reported cause of kidney failure associates with infection risk after dialysis initiation has been poorly studied. We quantified rates of infection-related hospitalization (IRH) by cause of kidney failure in patients newly initiated on dialysis in the US.

Methods

Using data from the United States Renal Data System (USRDS), we studied all adult patients (>=18 years) with kidney failure attributed to any of six selected glomerular disease subtypes, diabetic nephropathy [DN], or autosomal dominant polycystic kidney disease, who started dialysis as a first kidney failure treatment modality between 2005 and 2014. We used multivariable Prentice, Williams and Peterson (PWP) models to estimate hazard ratios for overall, 1st, 2nd and 3rd IRH for each cause of kidney failure.

Results

277,173 patients were included in this analysis. Compared to patients with IgA nephropathy (IgAN), those with MPGN, lupus nephritis (LN), vasculitis, or DN had higher overall IRH rates (20 vs. 30-36 events per 100 person years; p<0.05). Multivariable PWP models demonstrate that after adjustment for demographic and clinical covariates, patients with LN, vasculitis, or DN (vs. those with IgAN) had significantly higher hazards of 1st-3rd IRHs (adjusted HRs 1.14-1.44, p<0.05; Figure).

Conclusion

In US patients with kidney failure, the risk of IRH varied by reported cause of kidney failure. Specifically, patients with LN, vasculitis, or DN were at higher risks for IRH compared to patients with IgAN. These findings can inform patient counseling as well as the design of future studies examining pathogenic mechanisms and therapeutic interventions.

Adjusted hazards ratios for 1st-3rd infection-related hospitalization (IRH), adjusting for adjusted for demographic/clinical characteristics.