Associations of Dialysis Modality and Infectious Mortality in Incident Dialysis Patients in Australia and New Zealand

David W. Johnson, Hannah Dent, Carmel M. Hawley, Stephen McDonald, Johan B. Rosman, Fiona G. Brown, Kym M. Bannister, Kathryn J. Wiggins

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Background: The aim of the present investigation is to compare rates, types, causes, and timing of infectious death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients in Australia and New Zealand. Study Design: Observational cohort study using the Australian and New Zealand Dialysis and Transplant Registry data. Setting & Participants: The study included all patients starting dialysis therapy between April 1, 1995, and December 31, 2005. Predictor: Dialysis modality. Outcomes & Measurements: Rates of and time to infectious death were compared by using Poisson regression, Kaplan-Meier, and competing risks multivariate Cox proportional hazards model analyses. Results: 21,935 patients started dialysis therapy (first treatment PD, n = 6,020; HD, n = 15,915) during the study period, and 1,163 patients (5.1%) died of infectious causes (PD, 529 patients; 7.6% versus HD, 634 patients; 4.2%). Incidence rates of infectious mortality in PD and HD patients were 2.8 and 1.7/100 patient-years, respectively (incidence rate ratio PD versus HD, 1.66; 95% confidence interval [CI], 1.47 to 1.86). After performing competing risks multivariate Cox analyses allowing for an interaction between time on study and modality because of identified nonproportionality of hazards, PD consistently was associated with increased hazard of death from infection compared with HD after 6 months of treatment (<6 months hazard ratio [HR], 1.08; 95% CI, 0.76 to 1.54; 6 months to 2 years HR, 1.31; 95% CI, 1.09 to 1.59; 2 to 6 years HR, 1.51; 95% CI, 1.26 to 1.80; >6 years HR, 2.76; 95% CI, 1.76 to 4.33). This increased risk of infectious death in PD patients was largely accounted for by an increased risk of death caused by bacterial or fungal peritonitis. Limitations: Patients were not randomly assigned to their initial dialysis modality. Residual confounding and coding bias could not be excluded. Conclusions: Dialysis modality selection significantly influences risks, types, causes, and timing of fatal infections experienced by patients with end-stage kidney disease in Australia and New Zealand.

LanguageEnglish
Pages290-297
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume53
Issue number2
DOIs
Publication statusPublished - 1 Feb 2009

Keywords

  • Bacteremia
  • bacterial infection
  • continuous ambulatory peritoneal dialysis
  • fungal infection
  • hemodialysis
  • incidence
  • peritoneal dialysis
  • peritonitis
  • pneumonia
  • prevalence
  • septicemia
  • treatment modality
  • viral infection

ASJC Scopus subject areas

  • Nephrology

Cite this

Johnson, David W. ; Dent, Hannah ; Hawley, Carmel M. ; McDonald, Stephen ; Rosman, Johan B. ; Brown, Fiona G. ; Bannister, Kym M. ; Wiggins, Kathryn J. / Associations of Dialysis Modality and Infectious Mortality in Incident Dialysis Patients in Australia and New Zealand. In: American Journal of Kidney Diseases. 2009 ; Vol. 53, No. 2. pp. 290-297.
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title = "Associations of Dialysis Modality and Infectious Mortality in Incident Dialysis Patients in Australia and New Zealand",
abstract = "Background: The aim of the present investigation is to compare rates, types, causes, and timing of infectious death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients in Australia and New Zealand. Study Design: Observational cohort study using the Australian and New Zealand Dialysis and Transplant Registry data. Setting & Participants: The study included all patients starting dialysis therapy between April 1, 1995, and December 31, 2005. Predictor: Dialysis modality. Outcomes & Measurements: Rates of and time to infectious death were compared by using Poisson regression, Kaplan-Meier, and competing risks multivariate Cox proportional hazards model analyses. Results: 21,935 patients started dialysis therapy (first treatment PD, n = 6,020; HD, n = 15,915) during the study period, and 1,163 patients (5.1{\%}) died of infectious causes (PD, 529 patients; 7.6{\%} versus HD, 634 patients; 4.2{\%}). Incidence rates of infectious mortality in PD and HD patients were 2.8 and 1.7/100 patient-years, respectively (incidence rate ratio PD versus HD, 1.66; 95{\%} confidence interval [CI], 1.47 to 1.86). After performing competing risks multivariate Cox analyses allowing for an interaction between time on study and modality because of identified nonproportionality of hazards, PD consistently was associated with increased hazard of death from infection compared with HD after 6 months of treatment (<6 months hazard ratio [HR], 1.08; 95{\%} CI, 0.76 to 1.54; 6 months to 2 years HR, 1.31; 95{\%} CI, 1.09 to 1.59; 2 to 6 years HR, 1.51; 95{\%} CI, 1.26 to 1.80; >6 years HR, 2.76; 95{\%} CI, 1.76 to 4.33). This increased risk of infectious death in PD patients was largely accounted for by an increased risk of death caused by bacterial or fungal peritonitis. Limitations: Patients were not randomly assigned to their initial dialysis modality. Residual confounding and coding bias could not be excluded. Conclusions: Dialysis modality selection significantly influences risks, types, causes, and timing of fatal infections experienced by patients with end-stage kidney disease in Australia and New Zealand.",
keywords = "Bacteremia, bacterial infection, continuous ambulatory peritoneal dialysis, fungal infection, hemodialysis, incidence, peritoneal dialysis, peritonitis, pneumonia, prevalence, septicemia, treatment modality, viral infection",
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Associations of Dialysis Modality and Infectious Mortality in Incident Dialysis Patients in Australia and New Zealand. / Johnson, David W.; Dent, Hannah; Hawley, Carmel M.; McDonald, Stephen; Rosman, Johan B.; Brown, Fiona G.; Bannister, Kym M.; Wiggins, Kathryn J.

In: American Journal of Kidney Diseases, Vol. 53, No. 2, 01.02.2009, p. 290-297.

Research output: Contribution to journalArticle

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T1 - Associations of Dialysis Modality and Infectious Mortality in Incident Dialysis Patients in Australia and New Zealand

AU - Johnson, David W.

AU - Dent, Hannah

AU - Hawley, Carmel M.

AU - McDonald, Stephen

AU - Rosman, Johan B.

AU - Brown, Fiona G.

AU - Bannister, Kym M.

AU - Wiggins, Kathryn J.

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Y1 - 2009/2/1

N2 - Background: The aim of the present investigation is to compare rates, types, causes, and timing of infectious death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients in Australia and New Zealand. Study Design: Observational cohort study using the Australian and New Zealand Dialysis and Transplant Registry data. Setting & Participants: The study included all patients starting dialysis therapy between April 1, 1995, and December 31, 2005. Predictor: Dialysis modality. Outcomes & Measurements: Rates of and time to infectious death were compared by using Poisson regression, Kaplan-Meier, and competing risks multivariate Cox proportional hazards model analyses. Results: 21,935 patients started dialysis therapy (first treatment PD, n = 6,020; HD, n = 15,915) during the study period, and 1,163 patients (5.1%) died of infectious causes (PD, 529 patients; 7.6% versus HD, 634 patients; 4.2%). Incidence rates of infectious mortality in PD and HD patients were 2.8 and 1.7/100 patient-years, respectively (incidence rate ratio PD versus HD, 1.66; 95% confidence interval [CI], 1.47 to 1.86). After performing competing risks multivariate Cox analyses allowing for an interaction between time on study and modality because of identified nonproportionality of hazards, PD consistently was associated with increased hazard of death from infection compared with HD after 6 months of treatment (<6 months hazard ratio [HR], 1.08; 95% CI, 0.76 to 1.54; 6 months to 2 years HR, 1.31; 95% CI, 1.09 to 1.59; 2 to 6 years HR, 1.51; 95% CI, 1.26 to 1.80; >6 years HR, 2.76; 95% CI, 1.76 to 4.33). This increased risk of infectious death in PD patients was largely accounted for by an increased risk of death caused by bacterial or fungal peritonitis. Limitations: Patients were not randomly assigned to their initial dialysis modality. Residual confounding and coding bias could not be excluded. Conclusions: Dialysis modality selection significantly influences risks, types, causes, and timing of fatal infections experienced by patients with end-stage kidney disease in Australia and New Zealand.

AB - Background: The aim of the present investigation is to compare rates, types, causes, and timing of infectious death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients in Australia and New Zealand. Study Design: Observational cohort study using the Australian and New Zealand Dialysis and Transplant Registry data. Setting & Participants: The study included all patients starting dialysis therapy between April 1, 1995, and December 31, 2005. Predictor: Dialysis modality. Outcomes & Measurements: Rates of and time to infectious death were compared by using Poisson regression, Kaplan-Meier, and competing risks multivariate Cox proportional hazards model analyses. Results: 21,935 patients started dialysis therapy (first treatment PD, n = 6,020; HD, n = 15,915) during the study period, and 1,163 patients (5.1%) died of infectious causes (PD, 529 patients; 7.6% versus HD, 634 patients; 4.2%). Incidence rates of infectious mortality in PD and HD patients were 2.8 and 1.7/100 patient-years, respectively (incidence rate ratio PD versus HD, 1.66; 95% confidence interval [CI], 1.47 to 1.86). After performing competing risks multivariate Cox analyses allowing for an interaction between time on study and modality because of identified nonproportionality of hazards, PD consistently was associated with increased hazard of death from infection compared with HD after 6 months of treatment (<6 months hazard ratio [HR], 1.08; 95% CI, 0.76 to 1.54; 6 months to 2 years HR, 1.31; 95% CI, 1.09 to 1.59; 2 to 6 years HR, 1.51; 95% CI, 1.26 to 1.80; >6 years HR, 2.76; 95% CI, 1.76 to 4.33). This increased risk of infectious death in PD patients was largely accounted for by an increased risk of death caused by bacterial or fungal peritonitis. Limitations: Patients were not randomly assigned to their initial dialysis modality. Residual confounding and coding bias could not be excluded. Conclusions: Dialysis modality selection significantly influences risks, types, causes, and timing of fatal infections experienced by patients with end-stage kidney disease in Australia and New Zealand.

KW - Bacteremia

KW - bacterial infection

KW - continuous ambulatory peritoneal dialysis

KW - fungal infection

KW - hemodialysis

KW - incidence

KW - peritoneal dialysis

KW - peritonitis

KW - pneumonia

KW - prevalence

KW - septicemia

KW - treatment modality

KW - viral infection

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DO - 10.1053/j.ajkd.2008.06.032

M3 - Article

VL - 53

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EP - 297

JO - American Journal of Kidney Diseases

T2 - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

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ER -