Endocarditis in end stage renal disease
Endocarditis is a serious complication in patients undergoing renal replacement therapy (RRT). In the present study, researchers at the Herlev-Gentofte Hospital University of Copenhagen (Denmark) examine incidence and risk factors of endocarditis in patients with end stage renal disease (ESRD). They found a high incidence of endocarditis, in particular when hemodialysis treatment is conducted with central venous catheters. Significant risk factors for developing endocarditis were: the first six months in RRT, aortic valve disease, and previous endocarditis.
The analysis included all Danish patients initiating renal replacement (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD between 1996 and 2012, which corresponded to 10,612 patients (7,233 hemodialysis, 3,056 peritoneal dialysis, 323 pre-emptive kidney transplantation). 2.5 % of these patients developed endocarditis. The overall incidence of endocarditis was 627 per 100,000 person-years in RRT-patients. Hemodialysis patients had a higher incidence than those undergoing peritoneal dialysis or kidney transplantation (1092, 212, and 85 per 100,000 person-years, respectively).
Compared with patients in peritoneal dialysis, hazard ratios for endocarditis in patients receiving hemodialysis and kidney-transplanted recipients were 5.46 and 0.41. Hemodialysis recipients with central venous catheters had a more than twofold higher incidence of endocarditis than those with arteriovenous fistulas. The first six months in RRT, aortic valve disease, and previous endocarditis were found to be significant risk factors of endocarditis.
RRT-Patients, especially those using central venous catheters, have a high incidence of endocarditis.