Pneumonia in incident dialysis patients - The United States Renal Data System

Background. Although clinical experience suggests that pneumonia may occur frequently in dialysis patients, its clinical epidemiology in that group remains poorly defined. Methods. Medicare claims were used to identify pneumonia episodes in 289 210 patients initiating dialysis in the United States between 1996 and 2001 and followed until 31 December 2003. Results. Mean patient age was 63.8 years; 48.0% had diabetes and 9.6% used peritoneal dialysis as initial therapy. The overall incidence rate was 27.9/100 patient-years (29.0 in haemodialysis patients vs 18.2 in peritoneal dialysis patients, P < 0.0001) and remained relatively constant from year to year. On multivariate analysis, the primary associations of pneumonia [adjusted hazards ratio (AHR) >1.25 or <0.80, P < 0.0001] were chronic obstructive pulmonary disease (AHR 1.47), inability to transfer or ambulate (AHR 1.44), haemodialysis as initial therapy (AHR 1.41 vs peritoneal dialysis), age < 75 (AHR 1.40 vs 20-44 years), body mass index <30 kg/m² (AHR 0.77 vs 18.5-24.9 kg/m²) and age 0-19 years (AHR 0.61 vs 20-44 years). Survival probabilities after pneumonia were 0.51 at 1 year. Using interval Poisson regression analysis, AHRs were 4.99 (95% confidence interval 4.87-5.12) for death and 3.02 (2.89-3.16) for cardiovascular disease in the initial 6-month interval after pneumonia, declining to 2.12 (1.90-2.37) for death and 1.45 (1.12-1.87) for cardiovascular disease at 5 years. Conclusions. Common in dialysis patients, pneumonia is an antecedent association of cardiovascular disease and death.