Risk Factors for HD Patient Hospitalization for Infections Identified

These factors include lower serum albumin levels and vascular access other than an arteriovenous fistula at dialysis initiation.
These factors include lower serum albumin levels and vascular access other than an arteriovenous fistula at dialysis initiation.

Lower serum albumin levels and vascular access other than an arteriovenous fistula at dialysis initiation are among the risk factors for infection-related hospitalization among patients undergoing in-center hemodialysis (HD), according to a new study.

Other risk factors include age, inability to ambulate or transfer, and residence in a care facility at dialysis initiation.

“The findings from this study can be used to identify patients at higher risk for infection and inform the design of infection prevention strategies,” concluded a research team led by Lorien S. Dalrymple, MD, of the University of California, Davis.

Dr. Dalrymple and colleagues analyzed data from a sample of 135,545 Medicare beneficiaries starting in-center HD from 2005 to 2008. Of these, 38,475 (28%) experienced at least 1 infection-related hospitalization. The overall rate of infection-related hospitalization was 40.2 per 100 person-years.

Compared with a serum albumin level of 4 g/dL or higher at dialysis initiation, lower levels were associated with an increased rate of infection-related hospitalization, Dr. Dalrymple's group reported online ahead of print in the Clinical Journal of the American Society of Nephrology. For example, patients with levels of at least 3.0 but less than 3.5 g/dL had a 21% increased rate. Patients who started HD with a catheter or arteriovenous graft had a 59% and 37% increased rate of infection-related hospitalization compared with those who started dialysis with an arteriovenous fistula.

Compared with patients aged 45–64 years (reference), those aged 18–44, 65–74, and 75–84 years had a 12%, 14%, and 30% increased rate of infection-related hospitalization, respectively.

Inability to ambulate or transfer, chronic obstructive pulmonary disease, and residence in a care facility were associated with a 33%, 25%, and 51% increased rate, respectively.

Hospitalization rates were highest for infections associated with dialysis access or central venous catheters, bloodstream infections or sepsis, and pulmonary infections, with rates of 11.9, 10.2, and 8.4 hospitalizations per 100 person-years.

In an accompanying editorial, David T. Gilbertson, MD, and James B. Wetmore, MD, of the Chronic Disease Research Group in Minneapolis, Minn., commented that despite the study's limitations, the investigation by Dr. Dalrymple's team “provides important insights into infections in patients on dialysis, especially regarding the critical need to place permanent accesses as early as possible.”

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