title: Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients.
abstract: The impact of dialysis modality on infection, especially early in the course of dialysis, has not been well studied. This study compared infection between hemodialysis (HD) and peritoneal dialysis (PD) from the start of dialysis and evaluated factors that have an impact on infection risk. In this observational cohort study, all incident dialysis patients (n = 181; HD 119 and PD 62) at a single center from 1999 to 2005 had data collected prospectively beginning day 1 of dialysis. Excluded were those with any previous ESRD therapy. Infection rates were evaluated using multivariate Poisson regression. Overall infection rates were similar (HD 0.77 versus PD 0.86/yr; P = 0.24). Only HD patients had bacteremia (0.16/yr), and only PD patients had peritonitis (0.24/yr). Bacteremia that occurred < or =90 d after start of HD was 0.44/yr, increased compared with overall rate of 0.16/yr (P < 0.004). HD catheters, used in 67% of patients who started HD, were associated with a strikingly increased rate of bacteremia. Peritonitis < or =90 d was 0.22/yr, no different from the overall rate. Modality was not an independent predictor of overall infections (PD versus HD: relative risk 1.30; 95% confidence interval 0.93 to 1.8; P = 0.12) using multivariate analysis. PD and HD patients had similar infection rates overall, but type of infection and risk over time varied. HD patients had an especially high risk for bacteremia in the first 90 d, whereas the risk for peritonitis for the PD cohort was not different over time. These results support the placement of permanent accesses (fistula or PD catheter) before the start of dialysis to avoid use of HD catheters.
authors: Renal and Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors: Nabeel
authors: N
authors: Aslam
authors: Judith
authors: J
authors: Bernardini
authors: Linda
authors: L
authors: Fried
authors: Renee
authors: R
authors: Burr
authors: Beth
authors: B
authors: Piraino
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D016001:Confidence Intervals; D003928:Diabetic Nephropathies / Q000453:epidemiology; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000706:statistics & numerical data; D010538:Peritonitis / Q000453:epidemiology; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects* / Q000706:statistics & numerical data; D012307:Risk Factors