title: Epidemiologic features and long-term outcome of dialysis patients with infective endocarditis in Taiwan.
abstract: BACKGROUND
  The incidence of infective endocarditis (IE) is high in dialysis patients. Limited data are available on the risk factors for IE and long-term outcome after IE in dialysis patients, especially in Asian populations.
  
  
  METHODS
  We used Taiwan National Health Insurance Research Database to design a longitudinal cohort study. 68,426 ESRD patients who began dialysis between 1999 and 2007 were included. The follow-up period was from the start of dialysis to death, end of dialysis, or end of 2008. Cox proportional hazards models were used to identify the risk factors for IE.
  
  
  RESULTS
  IE was diagnosed in 502 patients during follow-up (201.4 per 100,000 person-years). Diabetes mellitus (DM), congestive heart failure (CHF), cerebro-vascular accident (CVA), and rheumatic heart disease (RHD) (HR: 3.07, 95% CI: 1.99-4.75) were associated with an increasing risk of development of IE. The cumulative incidence rate of IE in patients with RHD was 1.4, 2.2, and 3.9% at 1, 3, and 5 years. In-hospital mortality was 23.5%. Cumulative survival rates post-IE were 54.3% at 1 year and only 35.3% at 5 years.
  
  
  CONCLUSIONS
  Dialysis patients had a higher risk of IE. Those who were older and had DM, CHF, CVA, or especially RHD were at a greater risk. Dialysis patients with IE also had high mortality.
authors.affiliation: Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan; The Center of General Education, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Chou
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Jhi-Joung
authors.initials: JJ
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan; The Center of General Education, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Wen-Shiann
authors.initials: WS
authors.lastname: Wu
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.affiliation: Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Chung-Han
authors.initials: CH
authors.lastname: Ho
authors.affiliation: Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Zhe-Zhong
authors.initials: ZZ
authors.lastname: Lin
authors.affiliation: Department of Neurology, Occupational Medicine, Medical Information Management, Chi Mei Medical Center, Tainan, Taiwan; Department of Occupational Safety and Health, Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.
authors.forename: Tain-Junn
authors.initials: TJ
authors.lastname: Cheng
authors.affiliation: Department of Nephrology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan. Electronic address: ccchien58@yahoo.com.tw.
authors.forename: Chih-Chiang
authors.initials: CC
authors.lastname: Chien
mesh_terms: D004696:Endocarditis / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000401:mortality; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Dialysis; Infective endocarditis; Rheumatic heart disease