title: Association between acetylsalicylic acid and the risk of dialysis-related infections or septicemia among incident hemodialysis patients: a nested case-control study.
abstract: BACKGROUND
  Vascular access-related infections and septicemia are the main causes of infections among hemodialysis patients, the majority of them caused by Staphylococcus species. Acetylsalicylic acid (ASA) has recently been reported with a probable antistaphylococcal activity. This study aimed to evaluate the effect of ASA on the risk of dialysis-related infection and septicemia among incident chronic hemodialysis patients.
  
  
  METHODS
  In a nested case-control study, we identified 449 cases of vascular access-related infections and septicemia, and 4156 controls between 2001 and 2007 from our incident chronic hemodialysis patients' cohort. Cases were defined as patients hospitalized with a main diagnosis of vascular access-related infection or septicemia on the discharge sheet (ICD-9 codes). Up to ten controls per case were selected by incidence density sampling and matched to cases on age, sex and follow-up time. ASA exposure was measured at the admission and categorized as: no use, low dose (80-324 mg/d), high dose (≥325 mg/d). Odds ratios (OR) for infections were estimated using multivariable conditional logistic regression analysis, adjusting for potential confounders.
  
  
  RESULTS
  Compared to no use, neither dose of ASA was associated with a decreased risk of infection: low dose (OR 1.03, 95 % CI 0.82-1.28) and high dose (OR 1.30, 95 % CI 0.96-1.75). However, diabetes (OR = 1.32, 95 % CI = 1.07-1.62) and anticoagulant use (OR = 1.62, 95 % CI = 1.30-2.02) were associated with a higher risk.
  
  
  CONCLUSIONS
  Among hemodialysis patients, ASA use was not associated with a reduced risk of hospitalizations for dialysis-related infections or septicemia. However, ASA may remain beneficial for its cardiovascular indications.
authors.affiliation: Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada. hind.harrak@umontreal.ca.
authors.forename: Hind
authors.initials: H
authors.lastname: Harrak
authors.affiliation: Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada. isabelle.normand@mail.mcgill.ca.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Normand
authors.affiliation: Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada. rachel.grinker@sandoz.com.
authors.forename: Rachel
authors.initials: R
authors.lastname: Grinker
authors.affiliation: Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada. nelftouh.hmr@ssss.gouv.qc.ca.
authors.forename: Naoual
authors.initials: N
authors.lastname: Elftouh
authors.affiliation: Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada. louis-philippe.laurin@umontreal.ca.
authors.forename: Louis-Philippe
authors.initials: LP
authors.lastname: Laurin
authors.affiliation: Nephrology Unit, Maisonneuve-Rosemont Hospital Research Center, 5415, boul. de l'Assomption, Montreal (Quebec), H1T 2M4, Canada. jean-philippe.lafrance@umontreal.ca.|Department of Medicine, University of Montreal, Montreal, Canada. jean-philippe.lafrance@umontreal.ca.|Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, Canada. jean-philippe.lafrance@umontreal.ca.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Lafrance
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects*; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin