Infective endocarditis hospitalizations & outcomes in patients with end-stage kidney disease: a nationwide data-linkage study

Objective We investigated clinical features, microbiology, and outcomes of incident infective endocarditis (IE) hospitalizations in patients with end-stage kidney disease (ESKD) requiring dialysis or kidney transplantation over 25 years. Methods We conducted a retrospective, population-based cohort study linking national datasets in Scotland. Between 01/01/1990 and 12/31/2014, patients hospitalized with IE and with a history of ESKD were identified from national inpatient records and linked to national hospitalization and mortality data. From 01/01/2008, individual IE hospitalizations were additionally linked to national microbiology data. Multivariable logistic regression, adjusting for patient demographics and comorbidities, evaluated the association between ESKD and all-cause death at one and three years. Results Of 7,638 incident IE hospitalizations between 1990 and 2014, 2.8% (216/7,638) occurred in 210 patients with ESKD and 97.2% (7,422/7,638) occurred in 7,303 patients without ESKD. Positive blood cultures were identified in 42% (950/2,267) of incident IE hospitalizations from 2008. Staphylococcus aureus was isolated in 25.9% (21/81) and 12.8% (280/2,186) of patients with and without ESKD, respectively (p=0.002). ESKD was associated with an increased odds of death at one (44.9% versus 31.4%; adjusted odds ratio [aOR] 2.47, 95% confidence interval [CI] 1.85 to 3.30, p<0.001) and three years (63.9% versus 42.8%; aOR 3.77, 95% CI 2.79 to 5.12, p<0.001). Conclusions IE is associated with a poor prognosis in patients with ESKD, especially in the long-term. Compared to patients without ESKD, patients with ESKD were twice as likely to die within one year, and three times as likely to die within three years of IE hospitalization.