Infective endocarditis frequently occurs in end-stage renal disease (ESRD) patients and specific subgroups have higher risks, a new study finds.

According to linked data from the Danish National Registry on Regular Dialysis and Transplantation and the Danish National Patient registry, 10,612 patients (mean age 63 years; 36% female) started renal replacement therapy from 1996 to 2012, including 7233 on hemodialysis (HD), 3056 on peritoneal dialysis (PD), and 323 receiving kidney transplants (KT). Endocarditis developed in 2.5%, and 31 of these patients required valve surgery, Mavish Chaudry, MD, of Gentofte Hospital in Denmark, and colleagues reported online ahead of print in the Clinical Journal of the American Society of Nephrology. Given that rate, endocarditis would develop in 627 per 100,000 person-years among patients receiving renal replacement therapy, which is at least 60 times the rate found in general Danish population (purportedly 8 to 10 per 100,000 person-years). Of those developing endocarditis, 22% died in hospital and 51% within 1 year.

HD patients appeared the most prone to infective endocarditis. It was estimated to develop in 1092 HD, 212 PD, and 85 KT patients per 100,000 person-years. HD patients had 5.5 times higher risk compared with PD patients, with patients younger than 66 especially vulnerable; KT patients had less than half the risk.  

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Vascular access type impacted infection rates. Among HD recipients, those with central venous catheters had more than double the rate of endocarditis compared with patients who had arteriovenous fistulas and nearly triple the rate compared with patients who had arteriovenous grafts. Infection rates were similar for uncuffed and cuffed catheters (2099 vs 3053 per 100,000 person-years).

The team determined that specific factors predicted infective endocarditis including the first 6 months in renal replacement therapy (compared with after 2.3 years), aortic valve disease, and endocarditis prior to renal replacement.

Renewed efforts try to identify infective endocarditis are warranted, “This strongly advocates frequent use of both transthoracic and transesophageal echocardiography in the case of bacteremia or unexplained fever episodes in these patients,” Dr Chaudry and colleagues concluded.

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Chaudry MS, Carlson N, Gislason GH, et al. Risk of infective endocarditis in patients with end stage kidney disease. Clin J Am Soc Nephrol 12. doi: 10.2215/CJN.02320317