Epidemiologic features and long-term outcome of dialysis patients with infective endocarditis in Taiwan.

ABSTRACT

BACKGROUND: The incidence of infective endocarditis (IE) is high in dialysis patients. Limited data are available on the risk factors for IE and long-term outcome after IE in dialysis patients, especially in Asian populations. METHODS: We used Taiwan National Health Insurance Research Database to design a longitudinal cohort study. 68,426 ESRD patients who began dialysis between 1999 and 2007 were included. The follow-up period was from the start of dialysis to death, end of dialysis, or end of 2008. Cox proportional hazards models were used to identify the risk factors for IE. RESULTS: IE was diagnosed in 502 patients during follow-up (201.4 per 100,000 person-years). Diabetes mellitus (DM), congestive heart failure (CHF), cerebro-vascular accident (CVA), and rheumatic heart disease (RHD) (HR 3.07, 95% CI 1.99-4.75) were associated with an increasing risk of development of IE. The cumulative incidence rate of IE in patients with RHD was 1.4, 2.2, and 3.9% at 1, 3, and 5 years. In-hospital mortality was 23.5%. Cumulative survival rates post-IE were 54.3% at 1 year and only 35.3% at 5 years. CONCLUSION: Dialysis patients had a higher risk of IE. Those who were older and had DM, CHF, CVA, or especially RHD were at a greater risk. Dialysis patients with IE also had high mortality.