Long-term survival of dialysis patients with bacterial endocarditis in the United States

Am J Kidney Dis. 2004 Dec;44(6):1077-82. doi: 10.1053/j.ajkd.2004.08.030.


Background: The incidence of bacterial endocarditis is much greater in long-term dialysis patients compared with the general population, and chronic kidney disease has been postulated as an independent host-related risk factor. Limited data are available on the long-term survival of dialysis patients with endocarditis.

Methods: Dialysis patients hospitalized for bacterial endocarditis between 1977 and 2000 were studied retrospectively using data from the US Renal Data System database. Long-term survival was estimated by means of the life-table method. A Cox proportional hazards model was used to identify the impact of demographic characteristics and comorbidity on outcome.

Results: A total of 13,130 dialysis patients with bacterial endocarditis were identified. The in-hospital mortality rate for the entire cohort was 23.5%. Survival rates at 1, 2, 3, and 5 years were 45.9%, 33.3%, 24.3%, and 14.7% for patients hospitalized between 1977 and 1991 and 41.0%, 29.1%, 20.6%, and 10.9% for those hospitalized between 1992 and 1996, respectively. Survival rates at 1, 2, and 3 years were 38.4%, 25.3%, and 18.3% for patients hospitalized between 1997 and 2000, respectively. The most powerful independent predictors of all-cause death were age, diabetes as cause of end-stage renal disease, and cerebrovascular accident or transient ischemic attack as a comorbid condition.

Conclusion: Dialysis patients with bacterial endocarditis have poor long-term survival, even in the current treatment era, with survival rates changing little in the past 2 decades. Additional studies are needed to identify risk-reduction measures and develop additional treatment strategies for dialysis patients with endocarditis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Cohort Studies
  • Endocarditis, Bacterial / mortality*
  • Female
  • Hospitalization
  • Humans
  • Incidence
  • Kidney Failure, Chronic / microbiology
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Renal Dialysis*
  • Retrospective Studies
  • Survival Rate
  • Time*
  • United States / epidemiology