The clinical epidemiology of pneumonia in hemodialysis patients has received little attention. We linked the retrospective Waves 1, 3, and 4 Dialysis Morbidity and Mortality Study data sets (n = 10635) to Medicare claims to identify hospitalizations with pneumonia. Mean patient age was 60.3 years and duration of end-stage renal disease (ESRD) 3.8 years; 41.1% of patients had diabetes mellitus. Only 31.6% had received influenza vaccination in the 4 months preceding the study start date (January 1, 1994). The cumulative probability of pneumonia hospitalization was 0.09 at 1 year and 0.36 at 5 years. The main associations of hospitalization with pneumonia were age 45-64 years and ≥65 years (adjusted hazards ratio (AHR) 1.26 and 1.48 vs <45 years), chronic lung disease (AHR 1.62), ESRD duration ≥10 years (AHR 0.75 vs <5 years), body mass index (AHR 0.66 for 25.0-29.9, 0.58 for ≥30 vs <18.5 kg/m 2), serum albumin (AHR 0.74 for ≥4.06 vs ≤3.42), and transplantation as a time-dependent covariate (AHR 0.68). One- and 5-year post-pneumonia survival probabilities were 0.55 and 0.17 (vs 0.76 and 0.29 in the overall study population). Adjusted mortality hazards ratios were 4.08 (95% confidence interval (CI) 3.41-4.89) for the 0- to 6-month interval after pneumonia, 3.04 (95% CI 2.58-3.66) for 6- to 12-months, and 2.31 (95% CI 1.97-2.71) for 12-18 months, and remained approximately twofold thereafter. Hospitalization with pneumonia is common in hemodialysis patients and carries a poor prognosis.
Bibliographical noteFunding Information:
The data reported here have been supplied by the United States Renal Data System. This study was performed as a deliverable under Contract No. N01-DK-9-2343 (National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland). We thank Beth Forrest for manuscript preparation and Nan Booth, MSW, MPH, for manuscript editing.
- End-stage renal disease