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Li HL, Tai PH, Hwang YT, Lin SW, Lan LC. Causes of Hospitalization among End-Stage Kidney Disease Cohort before and after Hemodialysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10253. [PMID: 36011888 PMCID: PMC9408097 DOI: 10.3390/ijerph191610253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Patients with end-stage kidney disease (ESKD) have a greater risk of comorbidities, including diabetes and anemia, and have higher hospital admission rates than patients with other diseases. The cause of hospital admissions is associated with ESKD prognosis. This retrospective cohort study involved patients with ESKD who received hemodialysis and investigated whether the cause of hospital admission changed before versus after they started hemodialysis. This study recruited 592 patients with ESKD who received hemodialysis at any period between January 2005 and November 2017 and had been assigned the International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) code for ESKD. The patients' demographic data and hospitalization status one year before and two years after they received hemodialysis were analyzed. A McNemar test was conducted to analyze the diagnostic changes from before to after hemodialysis in patients with ESKD. The study's sample of patients with ESKD comprised more women (51.86%) than men and had an average age of 67.15 years. The numbers of patients admitted to the hospital for the following conditions all decreased significantly after they received hemodialysis: type 2 (non-insulin-dependent and adult-onset) diabetes; native atherosclerosis; urinary tract infection; gastric ulcer without mention of hemorrhage, perforation, or obstruction; pneumonia; reflux esophagitis; duodenal ulcer without mention of hemorrhage, perforation, or obstruction; and bacteremia. Most patients exhibited one or more of the following comorbidities: diabetes (n = 407, 68.75%), hypertension (n = 491, 82.94%), congestive heart failure (n = 161, 27.20%), ischemic heart disease (n = 125, 21.11%), cerebrovascular accident (n = 93, 15.71%), and gout (n = 96, 16.22%). An analysis of variance (ANOVA) indicated that changes in the ICD-9-CM codes for native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were associated with age. Patients who developed pneumonia before or after they received hemodialysis tended to be older (range: 69-70 years old). This study investigated the causes of hospital admission among patients with ESKD one year before and two years after they received hemodialysis. This study's results revealed hypertension to be the most common comorbidity. Regarding the cause of admission, pneumonia was more prevalent in older than in younger patients. Moreover, changes in the ICD-9-CM codes of native atherosclerosis, urinary tract infection, pneumonia, and hyperkalemia were significantly correlated with age. Therefore, when administering comprehensive nursing care and treatment for ESKD, clinicians should not only focus on comorbidities but also consider factors (e.g., age) that can affect patient prognosis.
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Affiliation(s)
- Hsiu-Lan Li
- Department of Nursing, Yunghe Cardinal Tien Hospital, New Taipei City 23148, Taiwan
- Graduate Institute of Management, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Pei-Hui Tai
- Medical Quality Control Room, En Chu Kong Hospital, New Taipei City 23148, Taiwan
| | - Yi-Ting Hwang
- Department of Statistics, National Taipei University, New Taipei City 23148, Taiwan
| | - Shih-Wei Lin
- Department of Information Management, Chang Gung University, Taoyuan City 33302, Taiwan
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung City 20641, Taiwan
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei City 23148, Taiwan
| | - Li-Ching Lan
- Department of Nursing, En Chu Kong Hospital, New Taipei City 23148, Taiwan
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Kim KY, Ryu JH, Kang DH, Kim SJ, Choi KB, Lee S. Early fluid management affects short-term mortality in patients with end-stage kidney disease undergoing chronic hemodialysis and requiring continuous renal replacement therapy. BMC Nephrol 2022; 23:102. [PMID: 35287625 PMCID: PMC8919557 DOI: 10.1186/s12882-022-02725-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 03/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Early fluid management is considered a key element affecting mortality in critically ill patients requiring continuous renal replacement therapy (CRRT). Most studies have primarily focused on patients with intrinsic acute kidney injury requiring CRRT, although end-stage kidney disease (ESKD) patients generally exhibit greater vulnerability. We investigated the association between fluid balance and short-term mortality outcomes in ESKD patients undergoing chronic hemodialysis and requiring CRRT. Methods This retrospective study included 110 chronic hemodialysis patients who received CRRT between 2017 and 2019 at Ewha Womans University Mokdong Hospital. The amounts of daily input and output, and cumulative 3-day and 7-day input and output, were assessed from the initiation of CRRT. The participants were classified into two groups based on 7-day and 14-day mortalities. Cox regression analyses were carried out on the basis of the amounts of daily input and output, cumulative input and output, and cumulative fluid balance. Results During follow-up, 7-day and 14-day mortalities were observed in 24 (21.8%) and 34 (30.9%) patients. The patients were stratified into two groups (14-day survivors vs. non-survivors), and there were no significant differences in demographic characteristics between the two groups. However, diabetes mellitus was more common among survivors than among non-survivors. Univariate analyses showed that the amounts of daily output at 48, and 72 h, and 3-day cumulative input and output, were significantly associated with 7-day mortality risk regardless of the cumulative fluid balance (HR: 0.28, 95% CI: 0.12–0.70, p = 0.01 for daily output at 48 h; HR: 0.34, 95% CI: 0.13–0.85, p = 0.02 for daily output at 72 h.; HR: 0.72, 95% CI: 0.61–0.86, p = 0.01 for 3-day cumulative input; HR: 0.65, 95% CI: 0.41–0.90, p = 0.01 for 3-day cumulative output). Adjusted multivariate analyses showed that the lower 3-day cumulative output is an independent risk factor for 7-day and 14-day mortality. Conclusions In our study, increased cumulative output were significantly associated with reduced short-term mortality risk in chronic hemodialysis patients undergoing CRRT regardless of cumulative fluid balance. Further prospective studies to investigate the association between fluid balance and mortality in ESRD patients requiring CRRT are warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02725-7.
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Affiliation(s)
- Kyun Young Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung-Hwa Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Duk-Hee Kang
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Shina Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
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Bou Chebl R, Tamim H, Abou Dagher G, Sadat M, Ghamdi G, Itani A, Saeedi A, Arabi YM. Sepsis in end-stage renal disease patients: are they at an increased risk of mortality? Ann Med 2021; 53:1737-1743. [PMID: 34632897 PMCID: PMC8510599 DOI: 10.1080/07853890.2021.1987511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 09/25/2021] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES This study aims to examine the outcome of end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU). DESIGN Single centre, retrospective cohort study. SETTING The study was conducted in the Intensive Care Department of King Abdulaziz Medical City, Riyadh, Saudi Arabia. PARTICIPANTS Data were extracted from a prospectively collected ICU database from 2002 to 2017. Patients were considered to have sepsis based on the sepsis-3 definition and were stratified into 2 groups based on the presence or absence of ESRD. PRIMARY AND SECONDARY OUTCOMES The primary outcome of the study was in-hospital mortality. Secondary outcomes included ICU mortality, ICU and hospital lengths of stay, and mechanical ventilation duration. RESULTS A total of 8803 patients were admitted to the ICU with sepsis during the study period. 730 (8.3%) patients had ESRD. 49.04% of ESRD patients with sepsis died within their hospital stay vs. 31.78% of non-ESRD patients. ESRD septic patients had 1.44 greater odds of dying within their hospital stay as compared to septic non-ESRD patients (OR 1.44, 95% CI 1.03-1.53). Finally, the predictors of hospital mortality in septic ESRD patients were found to be mechanical ventilation (OR 3.36; 95% CI 2.27-5.00), a history of chronic liver disease (OR 2.26; 95% CI 1.26-4.07), and use of vasopressors (OR 1.74; 95% CI 1.19-2.54). Among patients with ESRD, hospital mortality was higher in subgroups of patients with chronic cardiac (OR 1.86 (1.36-2.53) vs. 1.19 (0.96-1.47)) and chronic respiratory illnesses (OR 2.20 (1.52-3.20) vs. 1.21 (0.99-1.48)). CONCLUSION ESRD patients admitted to the intensive care unit with sepsis are at greater odds of mortality compared to patients with non-ESRD. This risk is particularly increased if these patients have a concomitant history of chronic cardiac and respiratory illnesses.Key MessagesSepsis and bacterial infections are very common in ESRD patients and following cardiovascular disease; sepsis is the second leading cause of death in patients with ESRD.This study aims to examine the outcome of patients with end-stage renal disease (ESRD) patients admitted with sepsis to the intensive care unit (ICU).The results of this study have shown that end-stage renal disease is associated with greater odds of ICU and hospital mortality among septic patients admitted to an intensive care unit.ESRD patients were also more likely to be started on vasopressors and mechanical ventilation.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Musharaf Sadat
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Ghassan Ghamdi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman Itani
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Alawi Saeedi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M. Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Kaur KP, Chaudry MS, Fosbøl EL, Østergaard L, Torp-Pedersen C, Bruun NE. Temporal changes in cardiovascular disease and infections in dialysis across a 22-year period: a nationwide study. BMC Nephrol 2021; 22:340. [PMID: 34654383 PMCID: PMC8518158 DOI: 10.1186/s12882-021-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/23/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) and infections are recognized as serious complications in patients with end stage kidney disease. However, little is known about the change over time in incidence of these complications. This study aimed to investigate temporal changes in CVD and infective diseases across more than two decades in chronic dialysis patients. METHODS All patients that initiated peritoneal dialysis (PD) or hemodialysis (HD) between 1996 and 2017 were identified and followed until outcome (CVD, pneumonia, infective endocarditis (IE) or sepsis), recovery of kidney function, end of dialysis treatment, death or end of study (December 31st, 2017). The calendar time was divided into 5 periods with period 1 (1996-2000) being the reference period. Adjusted rate ratios were assessed using Poisson regression. RESULTS In 4285 patients with PD (63.7% males) the median age increased across the calendar periods from 65 [57-73] in 1996-2000 to 69 [55-76] in 2014-2017, (p < 0.0001). In 9952 patients with HD (69.2% males), the overall median age was 71 [61-78] without any changes over time. Among PD, an overall non-significant decreasing trend in rate ratios (RR) of CVD was found, (p = 0,071). RR of pneumonia increased significantly throughout the calendar with an almost two-fold increase of the RR in 2014-2017 (RR 1.71; 95% CI 1.46-2.0), (p < 0.001), as compared to the reference period. The RR of IE decreased significantly until 2009 (RR 0.43; 95% CI 0.21-0.87), followed by a return to the reference level in 2010-2013 (RR 0.87; 95% CI 0.47-1.60 and 2014-2017 (RR 1.1; 95% CI 0.59-2.04). A highly significant (p < 0.001) increase in sepsis was revealed across the calendar periods with an almost 5-fold increase in 2014-2017 (RR 4.69 95% CI 3.69-5.96). In HD, the RR of CVD decreased significantly (p < 0.001) from 2006 to 2017 (RR 0.85; 95% CI 0.79-0.92). Compared to the reference period, the RR for pneumonia was high during all calendar periods (p < 0.05). The RR of IE was initially unchanged (p = 0.4) but increased in 2010-2013 (RR 2.02; 95% CI 1.43-2.85) and 2014-2017 (RR 3.39; 95% CI 2.42-4.75). No significant changes in sepsis were seen. CONCLUSION Across the two last decades the RR of CVD has shown a decreasing trend in HD and PD patients, while RR of pneumonia increased significantly, both in PD and in HD. Temporal trends of IE in HD, and particularly of sepsis in PD were upwards across the last decades.
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Affiliation(s)
- Kamal Preet Kaur
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
| | - Mavish Safdar Chaudry
- Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Lauge Østergaard
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark
- Clinical Institute, University of Copenhagen, Copenhagen, Denmark
- Clinical Institute, Aalborg University, Aalborg, Denmark
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Lubennikov AE, Petrovskii NV, Krupinov GE, Shilov EM, Trushkin RN, Kotenko ON, Glybochko PV. Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure. Nephron Clin Pract 2021; 145:164-170. [PMID: 33550285 DOI: 10.1159/000513168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. PATIENTS AND METHODS This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). RESULTS Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5-9) and 12.5 days (IQR: 9-16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7-9) in group I and 9 days (IQR: 9-11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5-305) than in group II equalling 115 min (IQR: 107.5-145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. CONCLUSION The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.
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Affiliation(s)
- Alexander E Lubennikov
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Nicolay V Petrovskii
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation,
| | - German E Krupinov
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Evgeniy M Shilov
- Clinic of Rheumatology, Nephrology and Occupational Pathology named after E.M. Tareev, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Roman N Trushkin
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Oleg N Kotenko
- Municipal Clinical Hospital No. 52 of the Moscow Department of Healthcare, Moscow, Russian Federation
| | - Petr V Glybochko
- Institute of Urology and Human Reproductive Health, First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
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Incidence and risk factors of sepsis in hemodialysis patients in the United States. J Vasc Surg 2020; 73:1016-1021.e3. [PMID: 32707386 DOI: 10.1016/j.jvs.2020.06.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sepsis is one the most serious and life-threatening complication in patients with chronic hemodialysis (HD) access. Arteriovenous fistula (AVF) use is associated with a lower risk of infection. However, several prior studies identified significantly higher number of patients initiating HD using a catheter (HC) or arteriovenous graft (AVG). The aim of this study was to use a large national renal database to report the incidence and risk factors of sepsis in patients with end-stage renal disease (ESRD) initiating HD access using AVF, AVG, or HC in the United States. METHODS All patients with ESRD initiating HD access (AVF, AVG, HC) between January 1, 2006, and December 31, 2014, in United States Renal Data System were included. International Classification of Diseases, 9th edition-Clinical Modification diagnosis code (038x, 790.7) was used to identify patients who developed first onset of sepsis during follow-up. Standard univariate (Students t-test, χ2, and Kaplan-Meier) and multivariable (logistic/Cox regression) analyses were performed as appropriate. RESULTS A total of 870,571 patients were identified, of whom, 29.8% (n = 259,686) developed sepsis. HC (31.2%) and AVG (30.6%) were associated with a higher number of septic cases compared with AVF (22.9%; P < .001). The incident rate of sepsis was 12.66 episodes per 100 person-years. It was the highest among HC vs AVG vs AVF (13.86 vs 11.49 vs 8.03 per 100 person-years). Patients with sepsis were slightly older (mean age 65.09 ± 14.49 years vs 63.24 ± 15.17 years) and had higher number of comorbidities including obesity (40.7% vs 37.7%), congestive heart failure (36.6% vs 30.8%), peripheral arterial disease (15.6% vs 12.4%), and diabetes (59.6% vs 53.5%) (all P < .001). After adjusting for potential confounders, compared with AVF, patients with AVG (hazard ratio [HR], 1.35 [95% confidence interval [CI], 1.31-1.40) and HC (HR, 1.80 [95% CI, 1.77-1.84) were more likely to develop sepsis at 3 years (both P < .001). Compared with patients with no sepsis, sepsis was associated with a three-fold increase the odds of mortality (odds ratio, 3.16; 95% CI, 3.11-3.21; P < .001). Additionally, in patients who developed sepsis, AVF use was associated with significantly lower mortality compared with AVG and HC (73.7% vs 78.7% vs 78.0%; P < .001). After adjusting for significant covariates, compared with AVF, mortality at 1 year after sepsis was 21% higher in AVG (HR, 1.21; 95% CI, 1.15-1.28; P < .001) and nearly doubled in HC (HR, 1.94; 95% CI, 1.88-2.00; P < .001). CONCLUSIONS Sepsis risk in HD patients is clearly related to access type and is associated with dramatic increase in mortality. Initiating HD access with AVF to meet the National Kidney Foundation Kidney Disease Outcomes Quality recommendations should be implemented to reduce the incidence of sepsis and improve survival in patients with ESRD.
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Zhang J, You X. Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis. Clin Rheumatol 2020; 39:3065-3069. [PMID: 32385760 DOI: 10.1007/s10067-020-05114-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/11/2020] [Accepted: 04/16/2020] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis (HD). We systematically reviewed medical records of 16 HD patients with septic arthritis admitted to our hospital from April 2008 to April 2018. A total of 16 HD in patients with bloodstream infection but without septic arthritis were randomly selected as controls. The incidence of septic arthritis in our patient group was 0.2% per year. Organisms isolated were Staphylococcus aureus in 11 (68.7%), Gram-negative bacilli in 3, streptococci in 1, and fungi in 1. Patients with septic arthritis were significantly older (72.7 ± 9.4 vs 63.5 ± 8.7 years, p = 0.035) and had more joint diseases (62.5% vs 12.5%, p = 0.003) and a longer duration of hospitalization (35.2 ± 5.7 vs 22.1 ± 3.5 days, p = 0.021) than the control group. In a logistic regression analysis, patients with older age and more joint diseases were more likely to have septic arthritis compared with controls (OR = 1.39, p = 0.024 and OR = 3.24, p = 0.003, respectively). These findings indicate that old age and joint diseases (osteoarthritis or inflammatory arthritis) were independent risk factors for septic arthritis in patients on HD when bloodstream infection occurred. Key Points • Patients with septic arthritis were significantly older and had more joint diseases than the control group. • Old age and joint diseases are independent risk factors for septic arthritis in patients on HD when bloodstream infection occurs.
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Affiliation(s)
- Jianna Zhang
- Department of Nephrology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Xiaohan You
- Department of Nephrology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
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Ducloux D, Legendre M, Bamoulid J, Rebibou JM, Saas P, Courivaud C, Crepin T. ESRD-associated immune phenotype depends on dialysis modality and iron status: clinical implications. Immun Ageing 2018; 15:16. [PMID: 30026783 PMCID: PMC6050655 DOI: 10.1186/s12979-018-0121-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND End-stage renal disease (ESRD) causes premature ageing of the immune system. However, it is not known whether hemodialysis (HD) and peritoneal dialysis (PD) similarly affect the T cell system. METHODS The aim of our study was to analyse whether dialysis modality may mitigate ESRD-induced immune senescence. We explored a large population of patients (675 ESRD patients) and both confirmed and refined the results in a second cohort (84 patients). RESULTS HD patients exhibited higher inflammatory monocytes counts (44/mm3 (1-520) vs 36/mm3 (1-161); p = 0.005). Patients on HD also had higher frequency of CD8 T cells (24% (7-61) vs 22% (8-42); p = 0.003) and reduced CD4/CD8 ratio. Such results were confirmed in the second cohort. Moreover, both CD4 + CD57 + CD28- (3.25% (0-38.2) vs 1.05% (0-28.5); p = 0.068) and CD8 + CD57 + CD28- (38.5% (3.6-76.8) vs 26.1 (2.1-46.9); p = 0.039) T cells frequencies were increased in HD patients. Telomere length did not differ according to dialysis modality, but was inversely related to ferritin levels (r = - 0.33; p = 0.003). There was a trend towards higher telomerase activity in PD patients (11 ± 13 vs 6 ± 11; p = 0.053). Thymic function was not different in PD and HD patients. Patients on PD before transplantation had a higher risk of acute rejection after kidney transplantation (HR, 1.61; 95%CI, 1.02 to 2.56; p = 0.041). CONCLUSIONS More pronounced inflammation with hemodialysis may induce premature aging of the immune system. This observation correlates with a lower risk of acute kidney rejection in patients previously on HD. Clinical consequences in patients maintained on dialysis should be determined. TRIAL REGISTRATION Trial registration: NCT02843867, registered July 8, 2016.
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Affiliation(s)
- Didier Ducloux
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Mathieu Legendre
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Dijon, Department of Nephrology, Dialysis, and Renal Transplantation, Dijon, France
| | - Jamal Bamoulid
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Jean-Michel Rebibou
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Dijon, Department of Nephrology, Dialysis, and Renal Transplantation, Dijon, France
| | - Philippe Saas
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- EFS Bourgogne Franche-Comté, Plateforme de Biomonitoring, INSERM CIC 1431/UMR1098, Besançon, France
| | - Cécile Courivaud
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
| | - Thomas Crepin
- INSERM, UMR1098, Federation Hospitalo-Universitaire, INCREASE, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Besançon, France
- Univ. Bourgogne-Franche-Comté, Faculté de Médecine et de Pharmacie, LabEx LipSTIC, Dijon, France
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, Besançon, France
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9
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Abstract
Sepsis is a global public health concern. Internationally it contributes to more than 5 million deaths annually. Although rates are variable between countries, over the past 40 years reported incidence has continued to increase. Aside from potential differences in patient populations, the variation in reported rates also reflects differences in identification strategies, access to health care, and awareness of the diagnosis. Factors such as age, sex, socioeconomic status, comorbid disease, and type and site of infection impact the development of and outcomes from sepsis. Although advances have been made in treatment, its impact remains substantial.
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Affiliation(s)
- Bourke Tillmann
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D1.08, Toronto, Ontario M4N 3M5, Canada
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room D1.08, Toronto, Ontario M4N 3M5, Canada; Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, 123 Edward Street, Toronto, ON M5G 1E2, Canada.
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