title: Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry.
abstract: BACKGROUND
  Infections and malignancies are the most common non-cardiovascular causes of death in patients on chronic renal replacement therapy (RRT). Here, we aimed to quantify the mortality risk attributed to infections and malignancies in dialysis patients and kidney transplant recipients when compared with the general population by age group and sex.
  
  
  METHODS
  We followed 168 156 patients included in the ERA-EDTA registry who started RRT in 1993-2007 until 1 January 2012. Age- and cause-specific mortality rates per 1000 person-years (py) and mortality rate ratios (MRRs) compared with the European general population (WHO) were calculated. To identify risk factors, we used Cox regression.
  
  
  RESULTS
  Infection-related mortality was increased 82-fold in dialysis patients and 32-fold in transplant recipients compared with the general population. Female sex, diabetes, cancer and multisystem disease were associated with an increased risk of infection-related mortality. The sex difference was most pronounced for dialysis patients aged 0-39 years, with women having a 32% (adjusted HR 1.32 95% CI 1.09-1.60) higher risk of infection-related mortality than men. Mortality from malignancies was 2.9 times higher in dialysis patients and 1.7 times higher in transplant recipients than in the general population. Cancer and multisystem disease as primary causes of end-stage renal disease were associated with higher mortality from malignancies.
  
  
  CONCLUSIONS
  Infection-related mortality is highly increased in dialysis and kidney transplant patients, while the risk of malignancy-related death is moderately increased. Young women on dialysis may deserve special attention because of their high excess risk of infection-related mortality. Further research into the mechanisms, prevention and optimal treatment of infections in this vulnerable population is required.
authors: ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Judith L
authors: JL
authors: Vogelzang
authors: ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Karlijn J
authors: KJ
authors: van Stralen
authors: ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Marlies
authors: M
authors: Noordzij
authors: Planning and Assurance Directorate, Aragon, Spain.
authors: Jose Abad
authors: JA
authors: Diez
authors: Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors: Juan J
authors: JJ
authors: Carrero
authors: REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine Cedex, Paris, France.
authors: Cecile
authors: C
authors: Couchoud
authors: Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
authors: Friedo W
authors: FW
authors: Dekker
authors: Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland Finnish Registry for Kidney Diseases, Helsinki, Finland.
authors: Patrik
authors: P
authors: Finne
authors: Service de Néphrologie-Dialyse-Nutrition, Hospices Civils de Lyon, Lyon, France.
authors: Denis
authors: D
authors: Fouque
authors: Department of Nephrology B, Copenhagen University Hospital at Herlev, Herlev, Denmark.
authors: James G
authors: JG
authors: Heaf
authors: Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors: Andries
authors: A
authors: Hoitsma
authors: Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Torbjørn
authors: T
authors: Leivestad
authors: Department of Nephrology, Dialysis & Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium.
authors: Johan
authors: J
authors: de Meester
authors: Scottish Renal Registry, Glasgow, UK.
authors: Wendy
authors: W
authors: Metcalfe
authors: Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors: Runolfur
authors: R
authors: Palsson
authors: U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
authors: Maurizio
authors: M
authors: Postorino
authors: Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, AL, Canada.
authors: Pietro
authors: P
authors: Ravani
authors: Nephrology Section, Ghent University Hospital, Ghent, Belgium.
authors: Raymond
authors: R
authors: Vanholder
authors: Department of Internal Medicine IV - Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria.
authors: Manfred
authors: M
authors: Wallner
authors: Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
authors: Jaap W
authors: JW
authors: Groothoff
authors: ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors: Kitty J
authors: KJ
authors: Jager
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology / Q000401:mortality*; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology / Q000401:mortality*; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D017582:Renal Replacement Therapy / Q000009:adverse effects* / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
keywords: dialysis; infections; malignancies; mortality; transplantation