Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age.

Danilo Lofaro,Jaap W Groothoff,Kitty J Jager,Karlijn J Van Stralen,Judith L Vogelzang

doi:10.1007/s00467-015-3209-0

Abstract

BackgroundPediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT.MethodsThe cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over non-infectious HAR ratio (HARR).ResultsThe HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001).ConclusionsOur findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.

Highlights

Patients starting renal replacement therapy (RRT) during the pediatric age and surviving long term are at a much higher risk of mortality compared with healthy peers, up to 30 times greater, according to long-term outcome studies
Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe urinary tract infections (UTIs) in transplantation
Bacterial infections were defined as any positive bacterial cultures, abscesses, UTIs, sepsis, tunnel/ central venous line infections, peritoneal dialysis (PD) peritonitis, sinusitis, segmental pneumonia, bilateral pneumonia with severe disease, pneumonia successfully treated with antibiotics, Bfever with chills and antibiotic treatment.^ Infections defined as viral included all diagnoses due to a specific virus, gastroenteritis except when indicated as bacterial, and upper airway infection

Summary

Introduction

Patients starting renal replacement therapy (RRT) during the pediatric age and surviving long term are at a much higher risk of mortality compared with healthy peers, up to 30 times greater, according to long-term outcome studies. By definition, these data concern historical patients who underwent a different approach compared with current practices. Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. We demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. We explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT

Methods

Results

Conclusion