Background: Patients undergoing dialysis for ESRD have frequent bacteremia and are at increased risk for IE, but their outcomes are unclear.
Methods: All ESRD patients admitted to 2 university hospitals from 1992-2012 were retrospectively screened for IE using ICD-9 codes. Chart reviews were performed and diagnosis of IE was confirmed using the modified Duke criteria. Categorical variables were compared using χ2or Fisher's exact test and continuous variables with the t-test. Mortality was assessed at 30 days, 1 year, and 3 years. Survival analysis was used to compare patients who did and did not undergo valve replacement surgery. A Cox proportional hazards model was used to calculate hazard ratios (HR) for death.
Results: Over 21 years, 258 ESRD patients had IE. Half were female, the median age was 55 years, and the mean duration of follow-up was 416 ± 627 days. Overall, 58% of patients had dialysis catheters, 21% had thrombocytopenia (² 150x109/L), 20% had embolic stroke, and 54% had a vegetation ³ 1.5cm. Staphylococci were the most common pathogens (24% MSSA, 21% MRSA, 18% coagulase negative). Mortality rates were 28% at 30 days, 57% at 1 year, and 76% at 3 years. 26% of patients underwent valve replacement surgery, which was associated with improved survival at 3 years compared to those who did not undergo surgery (figure 1, p=0.03). Age ³ 65 (HR 4.6, 95% CI 2.7–7.9), embolic stroke (HR 2.9, 95% CI 1.7 – 5.0), thrombocytopenia (HR 2.0, 95% CI 1.2 – 3.4), and prosthetic valve endocarditis (HR 2.3, 95% CI 1.1 – 4.9) predicted death in the multivariate analysis, while microbiology and vegetation size were not predictive of mortality.
Conclusion: ESRD patients with IE have high mortality, mostly due to non-modifiable risk factors. Efforts aimed at prevention and early diagnosis will likely have a greater benefit in decreasing mortality than altering current management strategies. Careful risk assessment for surgery should be performed in these patients.
J. T. Jacob, None