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Nephrol Dial Transplant. 2015 Jun;30(6):1028-37. doi: 10.1093/ndt/gfv007. Epub 2015 Jan 29.

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

Author information

1
ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
2
ERA-EDTA Registry, Department of Medical Informatics, J1b-113.1, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
3
Planning and Assurance Directorate, Aragon, Spain.
4
Division of Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
5
REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine Cedex, Paris, France.
6
Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
7
Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland Finnish Registry for Kidney Diseases, Helsinki, Finland.
8
Service de Néphrologie-Dialyse-Nutrition, Hospices Civils de Lyon, Lyon, France.
9
Department of Nephrology B, Copenhagen University Hospital at Herlev, Herlev, Denmark.
10
Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
11
Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
12
Department of Nephrology, Dialysis & Hypertension, AZ Nikolaas, Sint-Niklaas, Belgium.
13
Scottish Renal Registry, Glasgow, UK.
14
Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
15
U.O.C. Nefrologia, Dialisi e Trapianto, Azienda Ospedaliera di Reggio Calabria and CNR-IBIM, Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
16
Department of Medicine and Faculty of Medicine, University of Calgary, Calgary, AL, Canada.
17
Nephrology Section, Ghent University Hospital, Ghent, Belgium.
18
Department of Internal Medicine IV - Section of Nephrology, Klinikum Wels-Grieskirchen, Wels, Austria.
19
Division of Nephrology, University Clinic, University of Würzburg, Würzburg, Germany.
20
Department of Paediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

dialysis; infections; malignancies; mortality; transplantation

PMID:
25637641
DOI:
10.1093/ndt/gfv007
[Indexed for MEDLINE]

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