MO874: Incidence of Severe Infections in Home Haemodialysis and Peritoneal Dialysis Patients

Abstract

Abstract BACKGROUND Dialysis patients have a more than ten-fold risk of dying from infections compared with general population. In earlier studies, the risk of infections was similar in peritoneal dialysis (PD) and haemodialysis (HD), but comparison to home HD has not been performed. Our aim was to study the incidence of severe infections after start of home HD as compared with continuous ambulatory PD (CAPD) and automated PD (APD). METHODS We included all 536 adult patients, who were on home dialysis at day 90 from start of kidney replacement therapy (KRT) between 2004 and 2017 in Helsinki healthcare district. Severe infections were identified from patients’ laboratory data as a plasma C-reactive protein over 100 mg/L and confirmed from the patient data system. The cumulative incidence of the first severe infection was estimated considering death as a competing risk event. Hazard ratios of first severe infection were assessed using Cox regression with propensity score adjustment. Incidence rate (IR) and ratios (IRR) of all severe infection episodes were calculated. RESULTS The probability of getting a severe infection during the first year of dialysis was 35% for CAPD, 25% for APD and 11% for home HD patients. During a 5-year follow-up, the hazard ratio of severe infection was 2.8 [95% confidence interval (95% CI) 1.6–4.8] for CAPD and 2.2 (95% CI 1.4–3.5) for APD in comparison to home HD with adjustment for propensity scores. IR of infections/100 patient-years was 54 for CAPD, 37 for APD and 20 for home HD patients. The IR of peritonitis was 37 for CAPD and 25 for APD patients. When infection episodes caused by peritonitis were excluded, the IR of severe infections was not higher among PD than home HD patients. CONCLUSION The risk of severe infection was considerably lower among home HD than PD patients. This difference was mainly explained by the peritonitis episodes among the PD patients.