title: The Risk of Septicemia in End-Stage Renal Disease With and Without Renal Transplantation: A Propensity-Matched Cohort Study.
abstract: End-stage renal disease (ESRD) is a well-known risk factor for septicemia. Renal transplantation (RTx) is the treatment of choice for ESRD. However, RTx recipients should undergo long-term immunosuppressive therapy. The aim of this study was to evaluate the risk of septicemia in ESRD patients with and without RTx.This cohort study used the National Health Insurance (NHI) data of Taiwan from 2000 to 2010. The RTx group consisted of 3286 RTx recipients. The non-RTx comparison group also consisted of 3286 subjects with ESRD matched by propensity scores for age, sex, index date, comorbidities, and medications. The subjects were followed until the end of 2011 to evaluate the septicemia risk.The risk of septicemia was lower in the RTx group than the non-RTx group, with an adjusted hazard ratio of 0.73 [95% confidence interval (CI) = 0.64-0.84, P < 0.001]. In addition, we observed insignificantly lower intensive care unit (ICU) admission rate (35.8% vs. 39.8%) and lower 30-day all-cause mortality rate (17.2% vs. 18.5%) in the RTx group than the non-RTx group. However, the mean cost for septicemia in the RTx group was insignificantly higher than the non-RTx group (7175 vs. 6421 USD, P = 0.39).RTx recipients had a significantly reduced risk of developing septicemia compared to the propensity-matched non-RTx ESRD patients. The ICU admission and 30-day all-cause mortality rates also slightly decreased in RTx recipients but without statistical significance.
authors: From Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan (T-CS, I-KW, C-TT, F-CS, C-HK); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan (T-CS, T-CH); Intensive Care Unit, Chu Shang Show Chwan Hospital, Nantou, Taiwan (T-CS); Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan (I-KW); Division of Nephrology, Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan (C-CW); Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan (C-LL, F-CS); Division of Infection, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan (C-TT); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
authors: Te-Chun
authors: TC
authors: Shen
authors: I-Kuan
authors: IK
authors: Wang
authors: Chang-Ching
authors: CC
authors: Wei
authors: Cheng-Li
authors: CL
authors: Lin
authors: Chia-Ta
authors: CT
authors: Tsai
authors: Te-Chun
authors: TC
authors: Hsia
authors: Fung-Chang
authors: FC
authors: Sung
authors: Chia-Hung
authors: CH
authors: Kao
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D057216:Propensity Score; D018570:Risk Assessment; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology*