title: Clinical epidemiology of pneumonia in hemodialysis patients: the USRDS waves 1, 3, and 4 study.
abstract: The clinical epidemiology of pneumonia in hemodialysis patients has received little attention. We linked the retrospective Waves 1, 3, and 4 Dialysis Morbidity and Mortality Study data sets (n=10 635) to Medicare claims to identify hospitalizations with pneumonia. Mean patient age was 60.3 years and duration of end-stage renal disease (ESRD) 3.8 years; 41.1% of patients had diabetes mellitus. Only 31.6% had received influenza vaccination in the 4 months preceding the study start date (January 1, 1994). The cumulative probability of pneumonia hospitalization was 0.09 at 1 year and 0.36 at 5 years. The main associations of hospitalization with pneumonia were age 45-64 years and >/=65 years (adjusted hazards ratio (AHR) 1.26 and 1.48 vs <45 years), chronic lung disease (AHR 1.62), ESRD duration >/=10 years (AHR 0.75 vs <5 years), body mass index (AHR 0.66 for 25.0-29.9, 0.58 for >/=30 vs <18.5 kg/m(2)), serum albumin (AHR 0.74 for >/=4.06 vs </=3.42), and transplantation as a time-dependent covariate (AHR 0.68). One- and 5-year post-pneumonia survival probabilities were 0.55 and 0.17 (vs 0.76 and 0.29 in the overall study population). Adjusted mortality hazards ratios were 4.08 (95% confidence interval (CI) 3.41-4.89) for the 0- to 6-month interval after pneumonia, 3.04 (95% CI 2.58-3.66) for 6- to 12-months, and 2.31 (95% CI 1.97-2.71) for 12-18 months, and remained approximately twofold thereafter. Hospitalization with pneumonia is common in hemodialysis patients and carries a poor prognosis.
authors.affiliation: United States Renal Data System Coordinating Center, Minneapolis, Minnesota, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Slinin
authors.forename: R N
authors.initials: RN
authors.lastname: Foley
authors.forename: A J
authors.initials: AJ
authors.lastname: Collins
mesh_terms: D017677:Age Distribution; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology