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

Vogelzang, Judith L.; Stralen, Karlijn J. van; Noordzij, Marlies; Diez, Jose Abad; Carrero, Juan Jesús; Couchoud, Cécile; Dekker, Friedo W.; Finne, Patrik; Fouque, Denis; Heaf, James; Hoitsma, Andries J.; Leivestad, Torbjørn; Meester, Johan De; Metcalfe, Wendy; Pálsson, Runólfur; Postorino, Maurizio; Ravani, Pietro; Vanholder, Raymond; Wallner, Manfred; Wanner, Christoph; Groothoff, Jaap W.; Jager, Kitty J.

doi:10.1093/ndt/gfv007

Cited by 83 publications

(67 citation statements)

References 33 publications

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“…In a recent study on a large European end-stage kidney disease population from 1993 to 2007 with follow-up until 2012, Vogelzang et al demonstrated an all-cause long-term mortality of 67% in the studied period with a median follow-up of 3.7 years. Cardiovascular death accounted for 24.4%, whereas infections were ascribed as the cause of death in 11% [39]. However, hemodialysis patients with S. aureus endocarditis have an even higher one-year cardiovascular mortality and a higher long-term cardiovascular and all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis

et al. 2018

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BackgroundThe risk of infective endocarditis (IE) is markedly increased in patients receiving chronic hemodialysis compared with the general population, but outcome data are sparse. The present study investigated causes and risk factors of mortality in a hemodialysis-treated end-stage kidney disease- (ESKD) and a non-ESKD population with staphylococcus (S.) aureus endocarditis.MethodsHemodialysis-treated ESKD patients with S. aureus endocarditis were identified from Danish National Registries and Non-ESKD patients from The East Danish Database on Endocarditis. For establishing the cause of death The Danish Registry of Cause of Death was used. Independent risk factors of outcome were identified in multivariable Cox regression models.ResultsOne hundred twenty-one hemodialysis patients and 190 non-ESKD patients with S. aureus endocarditis were included during 1996–2012 and 2002–2012, respectively. The all-cause in-hospital mortality was 22.3% in hemodialysis- and 24.7% in non-ESKD patients. One-year mortality, excluding in-hospital mortality, was 26.4% in hemodialysis patients and 15.2% in non-ESKD patients.The hazard ratio of all-cause mortality in hemodialysis was 2.64 (95% CI 1.70–4.10) at > 70 days after admission compared with non-ESKD. Age (HR 1.03 (95% CI 1.02–1.04)) and diabetes mellitus (HR 2.17 (95% CI 1.54–3.10)) were independent risk factors of all-cause mortality. The hazard ratio of cardiovascular death in hemodialysis was 3.20 (95% CI 1.78–5.77) at > 81 days after admission compared with non-ESKD. Age and diabetes mellitus were independently related to cardiovascular death.ConclusionAll-cause in-hospital mortality rates were similar in hemodialysis and non-ESKD patients with S. aureus endocarditis whereas one-year mortality rates were significantly increased in the hemodialysis population.Electronic supplementary materialThe online version of this article (10.1186/s12882-018-1016-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis

et al. 2018

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“…The relative risk of cancer is increased when the glomerular filtration rate (GFR) is <60 ml/min, with men having a 29% increase in cancer risk for every 10 ml reduction in GFR [9] . In addition, mortality from cancers was also higher in dialysis patients than in the general population [10,11] . The postulated pathogenic mechanisms for cancer development in this group of patients include: altered DNA repair, impaired immune system function, decreased antioxidant defence, chronic infection and inflammation and accumulation of carcinogenic compounds [12] .…”

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confidence: 98%

Cancer Incidence and Mortality in Chronic Dialysis Population: A Multicenter Cohort Study

Cheung

Chan

et al. 2016

Am J Nephrol

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Background: Different studies in the past have shown that the risk of cancer development is increased in chronic dialysis patients. However, data concerning the cancer risk in Asian dialysis patients was scarce. More importantly, there was lack of information about the cancer-specific mortality in dialysis patients. Methods: A multicenter retrospective cohort study of 6,254 patients who started either chronic peritoneal dialysis or hemodialysis between 1994 and 2014 in 4 renal units in Hong Kong. Patterns of cancer incidence and mortality in our dialysis patients were compared with those of the general population using standardized incidence ratios (SIRs) and standardized mortality ratios (SMRs) respectively. Results: With 14,887 person-years of follow-up, 220 cancers were recorded. The SIR of all cancers was 1.44 (95% CI 1.26-1.65). A trend of an increased SIR was observed in young patients and within the first year of dialysis. Colorectum was the most common site of cancer (20%) while kidney cancer carried the highest risk (SIR 12.28, 95% CI 8.44-17.08). The SMR of all cancers was 0.91 (95% CI 0.72-1.13) and only kidney cancer had higher cancer mortality risk (SMR 4.92, 95% CI 1.80-10.70). SMR was highest in young patients and then decreased with age. Conclusions: The incidence of cancers in our chronic dialysis patients was elevated. Our findings of substantially increased risks in young patients, particularly in relation to kidney cancer, suggest that we can adopt a more individualized approach to cancer screening in chronic dialysis patients.

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“…39 Furthermore, among chronic dialysis patients, asymptomatic carriers of resistant bacteria are prevalent. [40][41][42] A curative approach to AML may be futile among patients in whom the predicted survival due to their kidney disease is short even prior to the development of leukemia.…”

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confidence: 99%

How I treat acute myeloid leukemia presenting with preexisting comorbidities

Ofran

Tallman

Rowe

2016

Blood

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Acute myeloid leukemia (AML) is a devastating disease with an incidence that progressively increases with advancing age. Currently, only ∼40% of younger and 10% of older adults are long-term survivors. If untreated, the overall prognosis of AML remains dismal. Initiation of therapy at diagnosis is usually urgent. Barriers to successful therapy for AML are the attendant toxicities directly related to chemotherapy or those associated with inevitable aplasia. Organ dysfunction often further complicates such toxicities and may even be prohibitive. There are few guidelines to manage such patients and the fear of crossing the medico-legal abyss may dominate. Such clinical scenarios provide particular challenges and require experience for optimal management. Herein, we discuss select examples of common pretreatment comorbidities, including cardiomyopathy, ischemic heart disease; chronic renal failure, with and without dialysis; hepatitis and cirrhosis; chronic pulmonary insufficiency; and cerebral vascular disease. These comorbidities usually render patients ineligible for clinical trials and enormous uncertainty regarding management reigns, often to the point of withholding definitive therapy. The scenarios described herein emphasize that with appropriate subspecialty support, many AML patients with comorbidities can undergo therapy with curative intent and achieve successful long-term outcome.

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

Cited by 83 publications

References 33 publications

The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis

The impact of hemodialysis on mortality risk and cause of death in Staphylococcus aureus endocarditis

Cancer Incidence and Mortality in Chronic Dialysis Population: A Multicenter Cohort Study

How I treat acute myeloid leukemia presenting with preexisting comorbidities

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