NEW YORK—Older patients using dialysis are frequently hospitalized for a broad range on infections—many of which are unrelated to dialysis access, according to a study published in the September issue of the American Journal of Kidney Diseases.
“Infection is an important cause of hospitalization and death in patients receiving dialysis,” the authors wrote. “Few studies have examined the full range of infections experienced by dialysis patients. The purpose of this study is to examine types, rates, and risk factors for infection in older persons starting dialysis therapy.”
In the retrospective observational cohort study, the researchers studied data from the U.S. Renal Data System that included patients aged 65-100 years who initiated dialysis therapy between Jan. 1, 2000, and Dec. 31, 2002.
The researchers excluded patients with a prior kidney transplant, unknown dialysis modality, or death, loss to follow-up, or transplant during the first 90 days of dialysis therapy. Patients were followed up until death, transplant, or study end on Dec. 31, 2004.
The study used discharge information from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to determine infection-related hospitalizations. Hospitalization rates were calculated for each type of infection.
In all, 119,858 patients were included in the study—7,401 of were using peritoneal dialysis. After a median follow-up of 1.9 years, infection-related diagnoses were observed in approximately 35 percent of all hospitalizations.
In addition, approximately 50 percent of the patients studied had at least one infection-related hospitalization. Rates (per 100 person-years) of pulmonary, soft-tissue, and genitourinary infections ranged from 8.3-10.3 in patients on peritoneal dialysis therapy and 10.2-15.3 in patients on hemodialysis therapy.
Risk factors for infection included older age, female sex, diabetes, heart failure, pulmonary disease, and low serum albumin level, according to the researchers.
