Etiology of bacterial septicemia in chronic dialysis patients in the United States.
OBJECTIVE
Previous studies have identified risk factors for and mortality associated with hospitalized septicemia (septicemia) in patients with end-stage renal disease (ESRD). However, the etiologies of septicemia in this population have not been determined.


METHODS
327,993 patients in the United States Renal Data System initiated on ESRD therapy between January 1, 1992, and June 30, 1997, who never received renal transplants were analyzed in a retrospective registry study of hospitalized cases of septicemia (ICD9 038.x).


RESULTS
Of the study population, 43,441 (13.2%) had septicemia. In logistic regression analysis, septicemia was associated with female gender, African American race, ESRD due to diabetes and obstruction/chronic pyelonephritis, increased age, and hemodialysis (vs. peritoneal dialysis). Polycystic kidney disease and glomerulonephritis were associated with decreased risk of septicemia. At initiation of dialysis, higher hemoglobin, and lower weight, creatinine, and albumin were associated with septicemia. Among patients with septicemia, the leading specified etiologies were Staphylococcus (34%) and miscellaneous Gram-negative rods (21.7%). Etiologies of septicemia were significantly associated with hemodialysis (Gram-positives and Pneumococcus), female gender (Gram-negatives except Pseudomonas), African American race (Staphylococcus), and diabetes (global). Hemodialysis (vs. peritoneal dialysis) and Staphylococcus as an etiology of septicemia were associated with repeated hospitalizations for septicemia. Septicemia was independently associated with patient mortality, and African Americans and females with septicemia were at disproportionately greater risk of mortality.


CONCLUSIONS
This study identifies significant associations between septicemia and female gender, African American race, hemodialysis, and higher hemoglobin. Significant associations between etiologies of septicemia and patient subgroups are also identified.
Abbott
K C
KC
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. kevin.abbott@na.amedd.army.mil.
Agodoa
L Y
LY
D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011552:Pseudomonas Infections / Q000209:etiology; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology; D013290:Streptococcal Infections / Q000209:etiology