title: Outcomes of infected cardiovascular implantable devices in dialysis patients.
abstract: OBJECTIVE
  Dialysis patients are at a higher risk for cardiovascular implantable electronic device (CIED) infection-related hospitalizations. We compared the outcomes and cost for dialysis and non-dialysis patients hospitalized with CIED infections.
  
  
  METHODS
  We conducted a retrospective analysis of the Nationwide Inpatient Sample (NIS) discharge records from 2005 to 2010. Patients with CIED infections were identified using ICD-9 codes for device-related infections or device procedure along with bacteremia, endocarditis or systemic infection. Dialysis patients were identified using ICD-9 codes. Multivariable logistic and linear regressions were performed to examine in-hospital mortality, length of stay and cost.
  
  
  RESULTS
  Of the 87,798 estimated hospitalizations with CIED infections, 6,665 (7.6%) were dialysis patients. CIED-infection-related hospitalization has increased over time among dialysis patients. In-hospital mortality was higher among dialysis patients (13.6% vs. 5.9%, p < 0.001). In the multivariable model, dialysis patients had higher odds of in-hospital mortality (odds ratio 1.98; 95% CI: 1.6, 2.4) compared to the non-dialysis group. Dialysis patients had a longer median length of stay (12 days vs. 7 days, p < 0.001) and majority required extended care facility upon discharge (51.2% vs. 35.0%, p < 0.001) compared to the non-dialysis group. Dialysis status was associated with 50.3% increased cost of hospitalization (p < 0.001).
  
  
  CONCLUSIONS
  CIED-infection related hospitalization is increasing among patients undergoing dialysis and is associated with higher in-hospital mortality, longer hospital stay and higher costs of hospitalization. Future studies should examine the reasons for such a high risk and find means to improve outcomes in dialysis population.
authors.affiliation: Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Oluwaseun
authors.initials: O
authors.lastname: Opelami
authors.forename: Ankit
authors.initials: A
authors.lastname: Sakhuja
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Liu
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.forename: Sankar D
authors.initials: SD
authors.lastname: Navaneethan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D016208:Databases, Factual; D017147:Defibrillators, Implantable; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000401:mortality* / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult