High mortality and characteristics of infections in dialysis patients

Abstract

Mortality and characteristics of infection were studied epidemiologically in dialysis patients known to be immunodeficient. The subjects were 7274 dialysis patients in 161 institutions in Japan. Among them 103 males and 61 females died from infections. Mortalities of infection in dialysis patients were 2189 case/105 persons·year in males and 2431 case/105 persons·year in females representing 61 fold in males and 116 fold in females of those among the age and sex adjusted general population. Frequent sites of infection caused deaths were lung, sepsis, peritoneum, liver, fistula and intestine. Primary sites of infection in sepsis were kidney, lung, wound, liver, peritoneum, gallbladder and bile-duct, stomatitis, fistula etc. Gram negative organisms accounted for 78% of isolates. The onsets of infection increased during the 3 months prior to the initiation of dialysis therapy. A remarkable rise in the number of onset of infection was seen during the 3 months after the initiation and the frequency tapered down thereafter although it remained high. Mean survived period was 18.4 days. Age distribution of dialysis patients died from infection was younger than that of the died in the age and sex adjusted control general population. Concerning the causative diseases for renal failure, the frequency of glomerulonephritis was lower and the frequencies of toxaemia of pregnancy, polycystic kidney and diabetes mellitus were higher than those of dialysis patients in all. Diagonostic findings and examinations for infections in dialysis patients were different from those usually seen in some aspects.