title: Pneumocystis jirovecii pneumonia in patients with end-stage renal disease: a comparison with the general population.
abstract: BACKGROUND
  Data on occurrence and risk factors for pneumocystis pneumonia (PCP) in patients with end-stage renal disease (ESRD) are sparse.
  
  
  METHODS
  This was a nationwide population-based study assessing occurrence and risk factors for PCP among patients with ESRD and population controls over a 21-year period (1/1 1990 to 31/12 2010). Using Danish registry data, first-time diagnoses of PCP were identified.
  
  
  RESULTS
  We identified 13 296 adult patients with ESRD and 244 255 controls, yielding 63 560 and 2 223 660 person-years of follow-up (PYFU), respectively. Fifty-eight first-time diagnoses of PCP were recorded in the ESRD group. Forty-six episodes occurred among renal transplant recipients (RTx) and 12 among haemodialysis patients (HD), yielding incidence rates of 181 (136-242) and 43.1 (24.5-75.9) per 100 000 PYFU. Compared to population controls, we found incidence rate-ratios of 125.9 (78.4-204) among RTx and 29.9 (14.1-59.7) among HD patients. Risk factors for PCP in RTx were age 50-65 years, age > 65 years, diabetes, polycystic kidney disease and hypertensive kidney disease/nephrosclerosis with an IRR of 2.22 (1.14-4.31), 3.12 (1.35-7.21), 3.44 (1.16-10.2), 4.25 (1.55-11.7) and 3.87 (1.49-10.0), respectively, and more than 36 months of dialysis before transplantation with an IRR of 1.99 (1.03-3.84). Among RTx the risk of PCP was highest during the first 6 months post-transplantation and increased from the beginning (IR1990-94 = 111 (46.3-267) per 100 000 PYFU) towards the end of the study period (IR2005-10 = 299 (203-439)).
  
  
  CONCLUSIONS
  The PCP risk is substantial in RTx within the first 6 months of transplantation, emphasizing the potential benefit of prophylactic treatment in the early post-transplant period. Importantly, we identified subgroups within the RTx group that require more attention.
authors.affiliation: From the Department of Infectious Diseases, Aarhus University Hospital , Aarhus.
authors.forename: Steffen
authors.initials: S
authors.lastname: Leth
authors.forename: Søren
authors.initials: S
authors.lastname: Jensen-Fangel
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.forename: Andreas Arendtsen
authors.initials: AA
authors.lastname: Rostved
authors.forename: Bente
authors.initials: B
authors.lastname: Jespersen
authors.forename: Ole Schmeltz
authors.initials: OS
authors.lastname: Søgaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii / Q000302:isolation & purification*; D011020:Pneumonia, Pneumocystis / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D066027:Transplant Recipients; D055815:Young Adult
keywords: End-stage renal disease; pneumocystis pneumonia; renal transplant recipients; risk factors