Dr CHANEL H. CHONG1,2, Dr ERIC H. AU1,2,3, Dr CHRISTOPHER E. DAVIES4,5, Dr ALLISON JAURE1,2, Dr MARTIN HOWELL1,2, Prof WAI H. LIM4,6, Prof JONATHAN C. CRAIG7, Prof ARMANDO TEIXEIRA-PINTO1,2, Prof GERMAINE WONG1,2,3
1School of Public Health, University of Sydney, Sydney, Australia, 2Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, Australia, 3Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia, 4Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute , Adelaide, Australia, 5Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 6Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia, 7College of Medicine and Public Health, Flinders University, Adelaide, Australia
Aim: To analyse the time-related trend of infection-related death in people on dialysis, compare the incidence of infection-related death with the general population, and define the associated risk factors.
Background: Infection is the third leading cause of death in the dialysis population but other epidemiological characteristics are uncertain.
Methods: Using the Australia and New Zealand Dialysis and Transplantation Registry, we included all adults commencing dialysis between 1980 and 2018 in Australia and New Zealand. Incidence of infection-related death was stratified by sex, age, time on dialysis, era and dialysis modality, and compared with the general population using standardised mortality ratios (SMR). Risk factors for infection-related death were analysed using competing risk analyses.
Results: 46,074 patients on haemodialysis and 20,653 on peritoneal dialysis were included and followed for 164,536 and 69,846 person-years, respectively. There were 38,463 deaths, with 12% assigned to infection. The infection mortality rates (per 10,000 person-years) were 185 and 232 (haemodialysis vs peritoneal dialysis), 184 and 219 (males vs females), 99, 181, 255 and 292 (age groups 18 – 44, 45 – 64, 65 – 74, >75 years), and 224 and 163 for those commencing dialysis in years 1980 – 2005 and 2006 – 2018. The overall SMR declined over time, from 138.0 (1980 – 1984) to 23.7 (2015 – 2018) (p < 0.001). Increased risk of infection-related death was associated with being female, older age, Aboriginal and/or Torres Strait Islander people, and of Maori descent. Additional risk factors were peritoneal dialysis, chronic lung disease, diabetes and vascular disease.
Conclusions: The risk of infection-related death in patients on dialysis remains 20 times higher than the general population, but has improved substantially over time.
Biography:
Completed her medical and nephrology training in New South Wales, Australia, and is a current Fellow of the Royal Australasian College of Physicians. She has since obtained a Master of Medicine (Clinical Epidemiology) at the University of Sydney and is currently undertaking research focusing on infection in the dialysis and transplant population