Abstract: SA-PO0357
Comparative Analysis of Ventilator-Associated Pneumonia Among Patients with ESKD on Maintenance Hemodialysis vs. Patients Without ESKD
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Shah, Ankur, Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- Snyder, Graham M, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Martin, Elise, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Raker, Christina A., Rhode Island Hospital, Providence, Rhode Island, United States
- Hu, Susie L., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
- D'Agata, Erika M.C., Brown University Warren Alpert Medical School, Providence, Rhode Island, United States
Background
Persons with end-stage kidney disease (ESKD) on maintenance hemodialysis (ESKD-HD) experience higher rates of infections compared to the general population. Despite this elevated risk, the relationship between ESKD and ventilator-associated pneumonia (VAP) remains poorly understood.
Methods
This retrospective cohort study utilized the National Inpatient Sample (2016-2020), maintained by the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, to examine VAP incidence, risk factors, and outcomes among mechanically ventilated patients with ESKD-HD compared to those without ESKD. Survey weighted logistic regression models and negative binomial models were used to evaluate VAP risk, mortality, and length of stay, controlling for demographics, comorbidities, and hospital characteristics. We stratified our analysis by time period to assess the impact of the COVID-19 pandemic, comparing VAP incidence, risk factors, and outcomes between pre-pandemic years (2016-2019) and the pandemic year (2020).
Results
We identified 3,615,730 hospitalized persons requiring mechanical ventilation, including 205,925 (5.7%) with ESKD-HD. ESKD-HD patients demonstrated significantly higher VAP incidence compared to non-ESKD patients (2.85% vs. 2.64%, p=0.023), with this association persisting after adjustment for demographics, comorbidities, and hospital characteristics [adjusted Odds Ratio (OR) 1.22, 95% Confidence Interval (CI) 1.13-1.31]. Among patients with VAP, those with ESKD-HD experienced higher in-hospital mortality (31.91% vs. 23.69%, p<0.001) and longer length of stay (36.97 vs. 27.85 days, p<0.001). Significant risk factors for VAP in ESKD-HD patients included advanced age (age ≥75: OR 1.38, 95% CI 1.08-1.76), male sex (OR 1.20, 95% CI 1.08-1.37) treatment in teaching hospitals (OR 2.34, 95% CI 1.84-2.97), and larger hospital size (OR 1.37, 95% CI 1.11-1.70). VAP incidence increased during the peak COVID-19 pandemic in 2020, for both groups, with no significant difference in relative impact between ESKD-HD and non-ESKD patients.
Conclusion
ESKD-HD are at heightened risk for developing VAP and experience worse outcomes. These findings underscore the need for enhanced VAP prevention strategies in this vulnerable population.
Funding
- Other NIH Support