Septic Arthritis in ESRD

Background:

End-stage renal disease (ESRD) patients are at increased risk for septic arthritis (SA). SA may predispose patients to adverse outcomes, including osteomyelitis (OM), joint replacement, amputation, and C. difficile infection (CDI). This study investigated risk for SA and these sequelae in ESRD patients.

Methods:

The cohort included adult incident hemodialysis patients in the United States Renal Data System from 2005 to 2010. SA cases, risk factors and outcomes were identified via ICD-9 and CPT-4 codes. A generalized linear model assuming a binomial distribution of the outcome was constructed to determine the adjusted relative risk (aRR) of potential risk factors. Statistical analysis was performed using SAS 9.4 at a significance level of 0.05.

Results:

7009 cases of SA were identified among 561,873 subjects, an incidence of 514.8 per 100,000 per year. 1769 (25.2%) subjects diagnosed with SA developed one of the specified sequelae. OM (n=785, 11.2%) was associated with underlying hepatitis C (aRR 2.08, 95%CI 1.06-4.06), MRSA infection (1.4, 1.2-1.64), and diabetes mellitus (1.40, 1.19-1.65). Amputation (n=457, 6.8%) was increased in diabetics (aRR 2.18, 1.72-2.77). Joint replacement (501, 7.1%) within 6 months was associated with history of joint prosthesis (5.16, 4.30-6.18). Increased risk for CDI (n=317, 4.5%) was associated with bacteremia (aRR = 2.66, 1.31-5.39).

Conclusion:

Incidence of SA in the ESRD population was 50-fold higher than previously reported in the general population. 25% of ESRD patients diagnosed with SA had a significant adverse outcome. With increased incidence and high rate of adverse outcomes, heightened awareness and early intervention for SA are warranted in the ESRD population.