Chaudry MS, et al. - This study focused on the incidence as well as risk factors of endocarditis in patients with ESRD. A high incidence of endocarditis was reported in patients receiving RRT, in particular during hemodialysis treatment using central venous catheters. Significant risk factors for developing endocarditis included first 6 months in RRT, aortic valve disease, and previous endocarditis.

Methods

• Using the Danish National Registry on Regular Dialysis and Transplantation, researchers estimated the incidence of endocarditis for each RRT modality (hemodialysis, peritoneal dialysis, or kidney transplantation) for ESRD.
• Researchers identified independent risk factors of endocarditis in multivariable Cox regression models.

Results

• Data showed that overall 10,612 patients (mean age 63 years, 36% female) initiated RRT (7233 hemodialysis, 3056 peritoneal dialysis, 323 pre-emptive kidney transplantation) from January 1, 1996 to December 31, 2012.
• A total of 267 (2.5%) developed endocarditis; of these 31 (12%) underwent valve surgery.
• Researchers found that the overall incidence of endocarditis was 627 per 100,000 person-years in patients receiving RRT.
• A higher incidence was reported in patients receiving hemodialysis vs those receiving peritoneal dialysis or kidney transplantation (1092 per 100,000 person-years, 212 per 100,000 person-years, and 85 per 100,000 person-years, respectively).
• Results revealed that adjusted hazard ratios for endocarditis in patients receiving hemodialysis were 5.46 (95% confidence interval [95% CI], 3.28 to 9.10) and 0.41 (95% CI, 0.18 to 0.91) for kidney-transplanted recipients, respectively, as compared with patients in peritoneal dialysis.
• Findings demonstrated that, compared with those with arteriovenous fistulas, the incidence of endocarditis in hemodialysis recipients with central venous catheters was more than two-fold higher.
• Following endocarditis, the overall mortality was 22% in-hospital and 51% at 1 year.
• Significant risk factors of endocarditis were: first 6 months in RRT, aortic valve disease, and previous endocarditis.