Abstract
BackgroundEnd stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. It has been reported to cause complications and even death among immunocompetent adults.MethodsA retrospective data collection on patients with varicella infection and ESRD in Singapore General Hospital (SGH) from the year 2005 to 2016 was performed. Continuous data and categorical data were summarized as median (range) and count (%) respectively. The association of health care utilization (total length of hospital stay, readmission related to varicella, intensive care unit admission) and mortality with complication due to varicella were tested using chi-square and Mann-Whitney test for categorical and continuous outcomes respectively.ResultsSixty-six patients with ESRD developed varicella during the study period (2005–2016). The case incidence rates for varicella among ESRD ranges from 97 to 267 per 100,000 populations with ESRD yearly. There were 9 deaths (13.6%). Mortality was higher among the ESRD patients with one or more varicella complications compared to patients without complications ((25% vs 7.1%, 95% CI for difference: − 1.1%, 36.9%, p = .063). Likewise, utilisation of intensive or high dependency units were higher among patients with complications compared to those without (20.8% vs 2.4%, 95% CI for difference: 1.6%, 35.3%, p = .012). Length of stay was twice as long in the group with complications compared to patients without (median (IQR) days: 14 (8, 21) vs 7 (5, 14), p = .065), although it did not reach statistical significance.ConclusionsVaricella is associated with high morbidity and significant mortality rate in ESRD patients. Varicella vaccination is recommended for seronegative ESRD patients.
Highlights
End stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore
Patients suffering from chronic kidney disease (CKD) and end stage renal disease (ESRD) / end stage renal failure (ESRF) are rising worldwide
During the 12 year observation period (2005–2016), a total of 66 patients with ESRD were admitted to Singapore General Hospital (SGH) for primary varicella infection
Summary
End stage renal disease (ESRD)/ end stage renal failure (ESRF) is on the rise globally and especially in Singapore. Varicella or chickenpox is not uncommon among adults especially ESRD/ESRF patients. Patients suffering from chronic kidney disease (CKD) and end stage renal disease (ESRD) / end stage renal failure (ESRF) (both ESRF and ESRD are referred to as ESRD) are rising worldwide. Incidence rates of ESRD/ ESRF is rising for many developing countries [1]. It was estimated there were 2.6 million people on dialysis in 2010; 93% from high or upper middle-income countries [2]. ESRD patients have impaired immune system and are susceptible to serious infections [4]. Patients on haemodialysis (HD) have 14–16 fold increased risk of mortality from pulmonary infections as compared with general population [5]
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