Pulmonary infectious mortality among patients with end-stage renal disease.
BACKGROUND
Infection is the second-leading cause of death among patients with end-stage renal disease (ESRD). This is due in part to advanced age, comorbid conditions, and immune dysfunction observed in uremic states. Although one may hypothesize that pulmonary infectious mortality is higher among patients with ESRD compared with the general population (GP), no such data are currently available.


METHODS
We compared annual pulmonary infectious mortality rates among patients with ESRD to those in the GP. The data were abstracted from the United States Renal Data System and the National Center for Health Statistics, respectively, and were stratified by age, gender, race, and presence or absence of diabetes mellitus (DM). In the GP, primary and multiple cause-of-death analyses were performed to account for potential limitations of the data sources.


RESULTS
Overall, pulmonary infectious mortality rate was 14-fold to 16-fold higher in dialysis patients and approximately twofold higher in renal transplant recipients compared with the GP. After stratification for age, differences between groups decreased but retained their magnitude.


CONCLUSIONS
Patients with ESRD treated with dialysis have higher pulmonary infectious mortality rates compared with the GP, even after stratification for age, race, and DM. Consequently, this patient population must be considered at high risk for the development of lethal pulmonary infections.
Sarnak
M J
MJ
Division of Nephrology, Department of Medicine, Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA. msarnak@lifespan.org
Jaber
B L
BL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000401:mortality*; D010531:Peritoneal Dialysis, Continuous Ambulatory; D018410:Pneumonia, Bacterial / Q000401:mortality*; D006435:Renal Dialysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology