title: High Risk of Prosthetic Valve Endocarditis and Death After Valve Replacement Operations in Dialysis Patients.
abstract: BACKGROUND
  Despite a high burden of dialysis access-related bloodstream infections and an increasing incidence of endocarditis, few data are available addressing the risk of prosthetic valve endocarditis (PVE) in the dialysis population. We sought to assess the risk of PVE and death after valve replacement operations in patients receiving long-term dialysis.
  
  
  METHODS
  A matched retrospective cohort study was conducted comprising patients admitted for valve replacement operations at two university hospitals. Patients without dialysis were matched 1:1 with dialysis patients by valve(s) replaced, year of operation, and presence of active endocarditis as the indication for valve replacement. Patient characteristics were compared using χ(2) and t tests. The development of PVE was defined by use of the modified Duke criteria and analyzed with Cox proportional hazards regression.
  
  
  RESULTS
  Two hundred seventy-eight patients were included, with 139 in either cohort. The PVE risk per year of follow-up was 0.14 in the dialysis cohort and 0.03 in the nondialysis cohort. Dialysis remained a risk factor (adjusted hazard ratio 5.61 [95% confidence interval, 2.17 to 14.5], p = 0.0004) after age and race were controlled for. The 5-year survival rate was lower after valve replacement operation in the dialysis group (25.4%) than in the nondialysis group (75.9%, p < 0.001).
  
  
  CONCLUSIONS
  The risk of PVE and death after valve replacement operations in dialysis patients is substantial and significantly higher than in patients without dialysis. These findings highlight the importance of a careful preoperative risk-benefit assessment and underscore the need to prevent hemodialysis-related bloodstream infections.
authors.affiliation: Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Danielle K
authors.initials: DK
authors.lastname: Farrington
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, Georgia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Kilgo
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address: jtjacob@emory.edu.
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Jacob
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: James P
authors.initials: JP
authors.lastname: Steinberg
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects; D016022:Case-Control Studies; D002423:Cause of Death; D004697:Endocarditis, Bacterial / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000401:mortality*; D012016:Reference Values; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis