Outcomes of Infection-Related Hospitalization according to Dialysis Modality

Clin J Am Soc Nephrol. 2015 May 7;10(5):817-24. doi: 10.2215/CJN.09210914. Epub 2015 Mar 27.

Abstract

Background and objectives: Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) compared with hemodialysis. The objective of this study was to compare mortality and overall readmission after an IRH between PD and hemodialysis.

Design, setting, participants, & measurements: This propensity score-matched retrospective cohort study assessed patients undergoing long-term dialysis patients, derived from the Canadian Organ Replacement Register and Régie de l'assurance maladie du Québec, who had at least one IRH between January 2001 and December 2007. Patients were followed until death, kidney transplantation, or end of the study period. To estimate the probability of receiving PD versus hemodialysis, propensity scores were obtained using multivariable logistic regression. Mortality and overall readmission risks after the initial IRH were compared using a Cox survival model.

Results: A total of 354 pairs of patients who had at least one IRH were matched for propensity score. During follow-up (median, 1.25 years), 138 hemodialysis patients (24.7/100 patient-years; 95% confidence interval [95% CI], 20.7 to 29.1) and 130 PD patients (21.2/100 patient-years; 95% CI, 17.7 to 25.1) died; 265 hemodialysis patients (144.6/100 patient-years; 95% CI, 127.7 to 163.1) and 299 PD patients (173.2/100 patient-years; 95% CI, 154.1 to 194.0) were readmitted for any cause; and 121 hemodialysis patients (29.7/100 patient-years; 95% CI, 24.7 to 35.5) and 168 PD patients (44.7/100 patient-years; 95% CI, 38.2 to 52.0) were readmitted for an infection. Compared with hemodialysis, PD was not associated with a different mortality risk after an IRH (hazard ratio [HR], 0.87; 95% CI, 0.69 to 1.11). PD was associated with a higher risk of infection-related overall readmission compared with hemodialysis (HR, 1.44; 95% CI, 1.14 to 1.81), but not with the risk of all-cause overall readmission (HR, 1.15; 95% CI, 0.98 to 1.36).

Conclusions: PD was not associated with higher mortality or all-cause overall readmission following an IRH compared with hemodialysis, but PD patients were at higher risk of infection-related overall readmission after IRH. IRHs are associated with significant mortality and overall readmissions. Evaluation of strategies to reduce infections in both hemodialysis and PD recipients are needed to improve patient care and outcomes.

Keywords: ESRD; chronic dialysis; epidemiology and outcomes; mortality; peritoneal dialysis.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Female
  • Hospital Mortality
  • Humans
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Patient Readmission / statistics & numerical data*
  • Peritoneal Dialysis / adverse effects
  • Peritoneal Dialysis / mortality
  • Pneumonia / microbiology
  • Pneumonia / mortality
  • Propensity Score
  • Quebec / epidemiology
  • Renal Dialysis / adverse effects*
  • Renal Dialysis / methods
  • Renal Dialysis / mortality*
  • Retrospective Studies
  • Risk Factors
  • Sepsis / etiology
  • Sepsis / mortality*
  • Time Factors