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Abstract: TH-PO334

Time Trends and Causes of Infectious Mortality Among Patients Starting Dialysis in Finland

Session Information

  • Home Dialysis - I
    November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Finne, Patrik, HUS-yhtyma, Helsinki, Uusimaa, Finland
  • Kinnunen, Susanna, Kuopion yliopistollinen sairaala, Kuopio, Pohjois-Savo, Finland
  • Helve, Jaakko, HUS-yhtyma, Helsinki, Finland
  • Juutilainen, Auni, Kuopion yliopistollinen sairaala, Kuopio, Pohjois-Savo, Finland
  • Bitar, Wisam, HUS-yhtyma, Helsinki, Uusimaa, Finland
  • Helantera, Ilkka, HUS-yhtyma, Helsinki, Uusimaa, Finland
Background

Infections are the second most common cause of death among dialysis patients. Still, there is very scarce information on recent trends and causes of infectious mortality among dialysis patients. Our aim was to evaluate the development of mortality caused by infectious diseases during the past decades in the dialysis population in Finland.

Methods

All adult patients who started chronic dialysis treatment in Finland during 2000–2019 were included. The patients were identified from the Finnish Registry for Kidney Diseases, and followed until kidney transplantation, death, five years from start of dialysis or end of 2019. Cumulative incidence of death caused by infections was calculated and deaths due to other causes were accounted for as competing risk events. Hazard ratios of infectious death were calculated according to time periods of dialysis start using Cox regression with adjustment for age, sex, primary kidney disease, and comorbidities.

Results

Altogether 9671 patients started dialysis of whom 75% commenced hemodialysis and 25% peritoneal dialysis. During the 5-year follow-up, 2956 (31%) patients received a kidney transplant, and 3692 (38%) dialysis patients died of whom 866 (23%) due to infections. The crude cumulative incidence of infectious death decreased steadily over five-year time periods during 2000–2019 (Figure). The hazard ratio of infectious death decreased continuously and was 0.50 (95% CI 0.39–0.61) for patients who started dialysis in 2015–2019 compared to 2000–2004. The most common causes of infectious death were septicemia (38%), pulmonary infection (36%), and peritonitis (8%). Invasive fungal, viral, or opportunistic infections rarely caused death.

Conclusion

Dialysis patients’ risk of dying due to infections has dropped by half since the beginning of the millennia. The reason for this development will need further studies.

Figure. Cumulative incidence of death due to infection according to time period of start of dialysis.

Funding

  • Private Foundation Support