Association of Dialysis Modality with Risk for Infection-Related Hospitalization

Lafrance, Jean‐Philippe; Rahme, Elham; Iqbal, Sameena; Elftouh, Naoual; Vallée, Michel; Laurin, Louis-Philippe; Ouimet, Denis

doi:10.2215/cjn.00440112

Cited by 45 publications

(58 citation statements)

References 21 publications

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“…In contrast to the work by Lafrance et al (21), which reported a relative risk of 1.52 (95% CI, 1.34 to 1.74) for infection-related hospitalization, we did not find a higher rate from overall infection in PD. Verger et al (9) reported a higher risk of peritonitis on assisted PD, but the differences disappeared when PD nurses from the dialysis center regularly visited patients to supervise the home care nurses.…”

Section: Discussioncontrasting

confidence: 99%

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

Oliver

Al-Jaishi

Dixon

et al. 2016

CJASN

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Background and objectives Assisted peritoneal dialysis is a treatment option for individuals with barriers to selfcare who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis.

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Section: Discussioncontrasting

confidence: 99%

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

Oliver

Al-Jaishi

Dixon

et al. 2016

CJASN

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“…While overall survival was similar between both modalities (13), PD was associated with a higher risk of death from infection compared with HD (14). Similarly, we have previously found that rates of all-cause hospitalization were equivalent between dialysis modalities but that PD was associated with a 52% increased risk of overall IRH compared with HD (15). This suggests that the higher risk of IRH was partly compensated for by a reduced risk of other causes of hospitalization.…”

Section: Introductionmentioning

confidence: 51%

“…Using the same cohort, we have previously shown a similar risk of all-cause hospitalization between PD and HD patients (15). However, PD was related to a 52% increased risk of IRH compared with HD.…”

Section: Discussionmentioning

confidence: 67%

“…Data sources and derivation of the incident dialysis cohort were described previously (15,16). The CORR gathers information on ESRD in Canada.…”

Section: Study Population and Data Sourcesmentioning

confidence: 99%

“…Third, we restricted analyses to patients with septicemia or a dialysis-related infection as their index IRH instead of all-cause infections that were considered in the main analysis (Supplemental Table 1). This second analysis was motivated by our previous findings that the increased risk of IRH associated with PD appeared to be mostly explained by a higher risk of dialysis-related hospitalizations, including for peritonitis (15).…”

Section: Additional Analysesmentioning

confidence: 99%

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Outcomes of Infection-Related Hospitalization according to Dialysis Modality

Laurin

Harrak

Elftouh

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) compared with hemodialysis. The objective of this study was to compare mortality and overall readmission after an IRH between PD and hemodialysis.Design, setting, participants, & measurements This propensity score-matched retrospective cohort study assessed patients undergoing long-term dialysis patients, derived from the Canadian Organ Replacement Register and Régie de l'assurance maladie du Québec, who had at least one IRH between January 2001 and December 2007. Patients were followed until death, kidney transplantation, or end of the study period. To estimate the probability of receiving PD versus hemodialysis, propensity scores were obtained using multivariable logistic regression. Mortality and overall readmission risks after the initial IRH were compared using a Cox survival model.Results A total of 354 pairs of patients who had at least one IRH were matched for propensity score. During follow-up (median, 1.25 years), 138 hemodialysis patients (24.7/100 patient-years; 95% confidence interval [95% CI], 20.7 to 29.1) and 130 PD patients (21.2/100 patient-years; 95% CI, 17.7 to 25.1) died; 265 hemodialysis patients (144.6/100 patient-years; 95% CI, 127.7 to 163.1) and 299 PD patients (173.2/100 patient-years; 95% CI, 154.1 to 194.0) were readmitted for any cause; and 121 hemodialysis patients (29.7/100 patient-years; 95% CI, 24.7 to 35.5) and 168 PD patients (44.7/100 patient-years; 95% CI, 38.2 to 52.0) were readmitted for an infection. Compared with hemodialysis, PD was not associated with a different mortality risk after an IRH (hazard ratio [HR], 0.87; 95% CI, 0.69 to 1.11). PD was associated with a higher risk of infection-related overall readmission compared with hemodialysis (HR, 1.44; 95% CI, 1.14 to 1.81), but not with the risk of all-cause overall readmission (HR, 1.15; 95% CI, 0.98 to 1.36).Conclusions PD was not associated with higher mortality or all-cause overall readmission following an IRH compared with hemodialysis, but PD patients were at higher risk of infection-related overall readmission after IRH. IRHs are associated with significant mortality and overall readmissions. Evaluation of strategies to reduce infections in both hemodialysis and PD recipients are needed to improve patient care and outcomes.

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Association between vitamin D receptor activator and the risk of infection‐related hospitalizations among incident hemodialysis patients: a nested case–control study

Normand

Elftouh

Laurin

et al. 2014

Pharmacoepidemiology and Drug

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Background Patients suffering from chronic kidney disease are at greater risk of developing infection than the normal population, and infections are the second cause of mortality after cardiovascular complications in this population. Some reports suggest that the intake of active vitamin D might be beneficial to prevent infections. Therefore, we aimed to determine if the oral intake of vitamin D receptor activator (VDRA) is associated with a lower risk of infection-related hospitalization (IRH) among incident chronic hemodialysis patients. Methods We conducted a nested case-control study in a cohort of 4933 patients initiating chronic hemodialysis between 1 January 2001 and 31 December 2007 in Quebec, Canada, using administrative databases. We identified cases of hospital admission indicating an infection as main diagnosis on the hospital's discharge sheet. Up to 10 controls were randomly selected for each case. Association between oral VDRA use and risk of IRH was estimated using conditional logistic regression. Results We identified 1136 cases of IRH and 10 396 controls during the study period. The intake of VDRA was not associated with the risk of being hospitalized due to an infection (odds ratio [OR], 1.07; 95% confidence interval [CI],. Using the prior 6-month cumulative dose of VDRA, we also found that a cumulative VDRA dose of less than 45 mcg (OR, 1.05; 95%CI, 0.92-1.19) or greater than 45 mcg (OR, 1.15; 95%CI, 0.96-1.36) was not associated with the IRH risk. Conclusions The oral intake of VDRA was not associated with the risk of IRH in incident hemodialysis patients.

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Association of Dialysis Modality with Risk for Infection-Related Hospitalization

Cited by 45 publications

References 21 publications

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis

Outcomes of Infection-Related Hospitalization according to Dialysis Modality

Association between vitamin D receptor activator and the risk of infection‐related hospitalizations among incident hemodialysis patients: a nested case–control study

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