Hospitalizations for bacterial septicemia in patients with end stage renal disease due to diabetes on the renal transplant waiting list.
The incidence and risk factors for hospitalizations for bacterial septicemia, a serious cause of morbidity and mortality in end stage renal disease (ESRD), have been studied separately for patients on chronic dialysis and after renal transplantation, but have not been compared directly. Using data from the USRDS, we studied 11,369 patients with ESRD due to diabetes enrolled on the renal and renal-pancreas transplant waiting list from 1 July 1994-30 June 1997. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for time to hospitalization for bacterial septicemia (ICD9 Code 038.x). In Cox Regression analysis, renal transplantation was independently associated with a shorter time to bacterial septicemia (HR 1.22, 95% confidence interval, 1.05-1.40). In addition, renal transplantation was associated with a higher rate of sepsis due to gram-negative organisms (HR 3.32, 95% CI 2.614.23) and urinary tract infection (10.43, 95% CI 6.72-16.17) compared with patients still on the renal transplant waiting list. The relative risk of sepsis increased with time after renal transplantation. Renal transplantation was associated with a significantly higher risk and different spectrum of bacterial septicemia than maintenance dialysis, and the risk of sepsis did not decrease over time.
Nephrology Service, Walter Reed Army Medical Center, Washington DC 20307-5001, USA. kevin.abbott@na.amedd.army.mil
Kevin C
KC
Abbott
Malcolm G
MG
Napier
Lawrence Y C
LY
Agodoa
D000328:Adult; D016470:Bacteremia / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014850:Waiting Lists