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Mortality from infections and malignancies in patients treated with renal replacement therapy: data from the ERA-EDTA registry.

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Authors
Vogelzang, Judith L
van Stralen, Karlijn J
Noordzij, Marlies
Diez, Jose Abad
Carrero, Juan J
Couchoud, Cecile
Dekker, Friedo W
Finne, Patrik
Fouque, Denis
Heaf, James G
Hoitsma, Andries
Leivestad, Torbjørn
de Meester, Johan
Metcalfe, Wendy
Palsson, Runolfur
Postorino, Maurizio
Ravani, Pietro
Vanholder, Raymond
Wallner, Manfred
Wanner, Christoph
Groothoff, Jaap W
Jager, Kitty J
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Issue Date
2015-06

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Citation
Nephrol. Dial. Transplant. 2015, 30 (6):1028-37
Abstract
Infections and malignancies are the most common non-cardiovascular causes of death in patients on chronic renal replacement therapy (RRT). Here, we aimed to quantify the mortality risk attributed to infections and malignancies in dialysis patients and kidney transplant recipients when compared with the general population by age group and sex.
We followed 168 156 patients included in the ERA-EDTA registry who started RRT in 1993-2007 until 1 January 2012. Age- and cause-specific mortality rates per 1000 person-years (py) and mortality rate ratios (MRRs) compared with the European general population (WHO) were calculated. To identify risk factors, we used Cox regression.
Infection-related mortality was increased 82-fold in dialysis patients and 32-fold in transplant recipients compared with the general population. Female sex, diabetes, cancer and multisystem disease were associated with an increased risk of infection-related mortality. The sex difference was most pronounced for dialysis patients aged 0-39 years, with women having a 32% (adjusted HR 1.32 95% CI 1.09-1.60) higher risk of infection-related mortality than men. Mortality from malignancies was 2.9 times higher in dialysis patients and 1.7 times higher in transplant recipients than in the general population. Cancer and multisystem disease as primary causes of end-stage renal disease were associated with higher mortality from malignancies.
Infection-related mortality is highly increased in dialysis and kidney transplant patients, while the risk of malignancy-related death is moderately increased. Young women on dialysis may deserve special attention because of their high excess risk of infection-related mortality. Further research into the mechanisms, prevention and optimal treatment of infections in this vulnerable population is required.
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Additional Links
http://dx.doi.org/ 10.1093/ndt/gfv007
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Archived with thanks to Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ae974a485f413a2113503eed53cd6c53
10.1093/ndt/gfv007
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English Journal Articles (Peer Reviewed)

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