Association between acetylsalicylic acid and the risk of dialysis-related infections or septicemia among incident hemodialysis patients: a nested case-control study.

BACKGROUND: Vascular access-related infections and septicemia are the main causes of infections among hemodialysis patients, the majority of them caused by Staphylococcus species. Acetylsalicylic acid (ASA) has recently been reported with a probable antistaphylococcal activity. This study aimed to evaluate the effect of ASA on the risk of dialysis-related infection and septicemia among incident chronic hemodialysis patients. METHODS: In a nested case-control study, we identified 449 cases of vascular access-related infections and septicemia, and 4156 controls between 2001 and 2007 from our incident chronic hemodialysis patients' cohort. Cases were defined as patients hospitalized with a main diagnosis of vascular access-related infection or septicemia on the discharge sheet (ICD-9 codes). Up to ten controls per case were selected by incidence density sampling and matched to cases on age, sex and follow-up time. ASA exposure was measured at the admission and categorized as: no use, low dose (80-324 mg/d), high dose (≥325 mg/d). Odds ratios (OR) for infections were estimated using multivariable conditional logistic regression analysis, adjusting for potential confounders. RESULTS: Compared to no use, neither dose of ASA was associated with a decreased risk of infection: low dose (OR 1.03, 95 % CI 0.82-1.28) and high dose (OR 1.30, 95 % CI 0.96-1.75). However, diabetes (OR = 1.32, 95 % CI = 1.07-1.62) and anticoagulant use (OR = 1.62, 95 % CI = 1.30-2.02) were associated with a higher risk. CONCLUSION: Among hemodialysis patients, ASA use was not associated with a reduced risk of hospitalizations for dialysis-related infections or septicemia. However, ASA may remain beneficial for its cardiovascular indications.

Association between vitamin D receptor activator and the risk of infection-related hospitalizations among incident hemodialysis patients: a nested case-control study.

BACKGROUND: Patients suffering from chronic kidney disease are at greater risk of developing infection than the normal population, and infections are the second cause of mortality after cardiovascular complications in this population. Some reports suggest that the intake of active vitamin D might be beneficial to prevent infections. Therefore, we aimed to determine if the oral intake of vitamin D receptor activator (VDRA) is associated with a lower risk of infection-related hospitalization (IRH) among incident chronic hemodialysis patients. METHODS: We conducted a nested case-control study in a cohort of 4933 patients initiating chronic hemodialysis between 1 January 2001 and 31 December 2007 in Quebec, Canada, using administrative databases. We identified cases of hospital admission indicating an infection as main diagnosis on the hospital's discharge sheet. Up to 10 controls were randomly selected for each case. Association between oral VDRA use and risk of IRH was estimated using conditional logistic regression. RESULTS: We identified 1136 cases of IRH and 10396 controls during the study period. The intake of VDRA was not associated with the risk of being hospitalized due to an infection (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.95-1.20). Using the prior 6-month cumulative dose of VDRA, we also found that a cumulative VDRA dose of less than 45 mcg (OR, 1.05; 95%CI, 0.92-1.19) or greater than 45 mcg (OR, 1.15; 95%CI, 0.96-1.36) was not associated with the IRH risk. CONCLUSIONS: The oral intake of VDRA was not associated with the risk of IRH in incident hemodialysis patients.

Generalized pustular psoriasis (von Zumbusch) following iatrogenic hypocortisolism.

Generalized pustular psoriasis can be triggered by hypocalcemia, pregnancy, stress and drugs but frequently has no obvious cause. We report a case which was only cured after treatment of iatrogenic adrenal axis suppression. A 41 year old woman had been suffering for nine months from a generalized pustular psoriasis which had occurred after a three week topical corticosteroid therapy of plaque psoriasis with 90 g of betamethasone dipropionate + 2% salicylic acid. Successive systemic treatments failed but topical corticosteroids brought relief to the patient. Cortisol level was found to be very low. Further investigations showed iatrogenic adrenal axis suppression. Hydrocortisone supplementation brought spectacular improvement and complete healing in a few months.We suggest that our patient was extremely sensitive to corticosteroids because the first pustules appeared after a conventional topical treatment. Adrenal axis suppression has never been involved in the aggravation of inflammatory dermatoses except in two cases of severe atopic dermatitis. Endogen corticosteroids inhibit proinflammatory cytokines by a feed-back mechanism and might have a great importance in the immune regulation loop. Cortisol level measurement should be considered in corticodependent inflammatory dermatoses.