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Pediatric Nephrology

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Open Access 01-02-2016 | Original Article

Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age

Authors: Danilo Lofaro, Judith L. Vogelzang, Karlijn J van Stralen, Kitty J. Jager, Jaap W. Groothoff

Published in: Pediatric Nephrology | Issue 2/2016

Abstract

Background

Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT.

Methods

The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over non-infectious HAR ratio (HARR).

Results

The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001).

Conclusions

Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.

Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, van de Kar NJ, Wolff ED, Davin JC, Heymans HS (2002) Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int 61:621–629PubMedCrossRef

McDonald SP, Craig JC (2004) Long-term survival of children with end-stage renal disease. N Engl J Med 350:2654–2662PubMedCrossRef

Samuel SM, Tonelli MA, Foster BJ, Alexander RT, Nettel-Aguirre A, Soo A, Hemmelgarn BR (2011) Survival in pediatric dialysis and transplant patients. Clin J Am Soc Nephrol 6:1094–1099PubMedPubMedCentralCrossRef

Chavers BM, Molony JT, Solid CA, Rheault MN, Collins AJ (2015) One-year mortality rates in US children with end-stage renal disease. Am J Nephrol 41:121–128PubMedCrossRef

Chesnaye N, Bonthuis M, Schaefer F, Groothoff J, Verrina E, Heaf J, Jankauskiene A, Lukosiene V, Molchanova E, Mota C, Peco-Antić A, Ratsch I-M, Bjerre A, Roussinov D, Sukalo A, Topaloglu R, Van Hoeck K, Zagozdzon I, Jager K, Van Stralen K (2014) Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA–EDTA registry. Pediatr Nephrol 29:2403–2410PubMedCrossRef

de Jager DJ, Grootendorst DC, Jager KJ, van Dijk PC, Tomas LM, Ansell D, Collart F, Finne P, Heaf JG, De MJ, Wetzels JF, Rosendaal FR, Dekker FW (2009) Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA 302:1782–1789PubMedCrossRef

Steenkamp R, Shaw C, Feest T (2013) UK Renal Registry 15th annual report: Chapter 5 survival and causes of death of UK adult patients on renal replacement therapy in 2011: national and centre-specific analyses. Nephron Clin Pract 123 [Suppl 1]:93–123PubMedCrossRef

Bouwcollege (CBZ) (2003) Developments in the use of hospital beds. I. (Ontwikkelingen bedgebruik ziekenhuizen, deel 1). Utrecht: National Board for Hospital Facilities, in Dutch, English summary

Chavers BM, Solid CA, Gilbertson DT, Collins AJ (2007) Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States. J Am Soc Nephrol 18:952–959PubMedCrossRef

10.

Aslam N, Bernardini J, Fried L, Burr R, Piraino B (2006) Comparison of infectious complications between incident hemodialysis and peritoneal dialysis patients. Clin J Am Soc Nephrol 1:1226–1233PubMedCrossRef

11.

Comoli P, Ginevri F (2012) Monitoring and managing viral infections in pediatric renal transplant recipients. Pediatr Nephrol 27:705–717PubMedCrossRef

12.

Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease, 1990–2010. JAMA 309:1921–1929PubMedPubMedCentralCrossRef

13.

Pastan S, Soucie JM, McClellan WM (2002) Vascular access and increased risk of death among hemodialysis patients. Kidney Int 62:620–626PubMedCrossRef

14.

Vanholder R, Van Biesen W (2002) Incidence of infectious morbidity and mortality in dialysis patients. Blood Purif 20:477–480PubMedCrossRef

15.

Dharnidharka VR, Stablein DM, Harmon WE (2004) Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS. Am J Transplant 4:384–389PubMedCrossRef

16.

Chopra I, Hesse L, O'Neill A (2002) Discovery and development of new anti-bacterial drugs. In: van der Goot H (ed) Trends in drug research III. Elsevier Science, Amsterdam, pp 213–225CrossRef

17.

Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW (2013) Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood. Nephrol Dial Transplant 28:2082–2089PubMedCrossRef

18.

North American Pediatric Renal Trials and Collaborative Studies (2010) NAPRTCS 2010 annual transplantation report. Available at: https://web.emmes.com/study/ped/annlrept/2010_Report.pdf

19.

North American Pediatric Renal Trials and Collaborative Studies (2011) NAPRTCS 2011 annual dialysis report. Available at: https://web.emmes.com/study/ped/annlrept/annualrept2011.pdf

20.

Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, Gassman JJ, Kaufman AM, Kaysen GA, Lewis JA, Schwab SJ (2003) Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol 14:1863–1870PubMedCrossRef

21.

Dupont PJ, Manuel O, Pascual M (2010) Infection and chronic allograft dysfunction. Kidney Int Suppl (119)S47–S53

22.

Johnson DW, Dent H, Hawley CM, McDonald SP, Rosman JB, Brown FG, Bannister KM, Wiggins KJ (2009) Associations of dialysis modality and infectious mortality in incident dialysis patients in Australia and New Zealand. Am J Kidney Dis 53:290–297PubMedCrossRef

23.

Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, Piera L, Bragg-Gresham JL, Feldman HI, Goodkin DA, Gillespie B, Wolfe RA, Held PJ, Port FK (2004) Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 19:108–120PubMedCrossRef

24.

Development Core Team R (2011) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria

25.

Kosmadakis G, Daikos GL, Pavlopoulou ID, Gobou A, Kostakis A, Tzanatou-Exarchou H, Boletis JN (2013) Infectious complications in the first year post renal transplantation. Transplant Proc 45:1579–1583PubMedCrossRef

26.

Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, West MS, Sillix DH, Chandrasekar PH, Haririan A (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 20:401–409PubMedCrossRef

27.

United States Renal Data System (2012) Transplantation. USRDS 2012 annual data report: atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, p 290. Available from http://www.usrds.org

28.

Galindo Sacristan P, Perez Marfil A, Osorio Moratalla JM, de Gracia Guindo C, Ruiz Fuentes C, Castilla Barbosa YA, Garcia Jimenez B, de Teresa Alguacil J, Barroso Martin FJ, Osuna Ortega A (2013) Predictive factors of infection in the first year after kidney transplantation. Transplant Proc 45:3620–3623PubMedCrossRef

29.

Pruthi R, Casula A, MacPhee I (2013) UK Renal Registry 15th annual report: demographic and biochemistry profile of kidney transplant recipients in the UK in 2011: national and centre-specific analyses. Nephron Clin Pract 123 [Suppl 1]:55–80PubMed

30.

United States Renal Data System (2013) Transplantation. USRDS 2013 annual data report: atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Available from http://www.usrds.org

31.

Ekberg H, Tedesco-Silva H, Demirbas A, Vitko S, Nashan B, Gurkan A, Margreiter R, Hugo C, Grinyo JM, Frei U, Vanrenterghem Y, Daloze P, Halloran PF (2007) Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med 357:2562–2575PubMedCrossRef

32.

United States Renal Data System (2007) Transplantation. USRDS 2007 annual data report: atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. Available from http://www.usrds.org

33.

Parasuraman R, Abouljoud M, Jacobsen G, Reddy G, Koffron A, Venkat KK (2011) Increasing trend in infection-related death-censored graft failure in renal transplantation. Transplantation 91:94–99PubMedCrossRef

34.

Kho M, Cransberg K, Weimar W, van Gelder T (2011) Current immunosuppressive treatment after kidney transplantation. Expert Opin Pharmacother 12:1217–1231PubMedCrossRef

35.

Nashan B, Curtis J, Ponticelli C, Mourad G, Jaffe J, Haas T (2004) Everolimus and reduced-exposure cyclosporine in de novo renal-transplant recipients: a three-year phase II, randomized, multicenter, open-label study. Transplantation 78:1332–1340PubMedCrossRef

36.

Vitko S, Wlodarczyk Z, Kyllonen L, Czajkowski Z, Margreiter R, Backman L, Perner F, Rigotti P, Jaques B, Abramowicz D, Kessler M, Sanchez-Plumed J, Rostaing L, Rodger RS, Donati D, Vanrenterghem Y (2006) Tacrolimus combined with two different dosages of sirolimus in kidney transplantation: results of a multicenter study. Am J Transplant 6:531–538PubMedCrossRef

37.

Howell DN, Miller SE (2005) Viral infections in solid organ transplants: hitting a moving target. Microsc Microanal 11:966–967CrossRef

38.

Säemann M, Hörl WH (2008) Urinary tract infection in renal transplant recipients. Eur J Clin Invest 38:58–65PubMedCrossRef

39.

Schold JD, Rehman S, Kayle LK, Magliocca J, Srinivas TR, Meier-Kriesche HU (2009) Treatment for BK virus: incidence, risk factors and outcomes for kidney transplant recipients in the United States. Transpl Int 22:626–634PubMedCrossRef

40.

Wojciechowski D, Chandran S (2013) Effect of ciprofloxacin combined with sulfamethoxazole-trimethoprim prophylaxis on the incidence of urinary tract infections after kidney transplantation. Transplantation 96:400–405PubMedCrossRef

41.

Green H, Rahamimov R, Gafter U, Leibovitci L, Paul M (2011) Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: a systematic review and meta-analysis. Transpl Infect Dis 13:441–447PubMedCrossRef

42.

Taneja C, Zervos M, Haque N, Moore C, Reyes K, Spalding J, Jiang J, Oster G (2009) Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis 15(9):1516–1518PubMedPubMedCentralCrossRef

43.

Trotter CL, Stuart JM, George R, Miller E (2008) Increasing hospital admissions for pneumonia, England. Emerg Infect Dis 14:727–733PubMedPubMedCentralCrossRef

44.

Nessim SJ, Bargman JM, Austin PC, Story K, Jassal SV (2009) Impact of age on peritonitis risk in peritoneal dialysis patients: an era effect. Clin J Am Soc Nephrol 4:135–141PubMedPubMedCentralCrossRef

45.

Van Esch S, Krediet RT, Struijk DG (2014) 32 years' experience of peritoneal dialysis-related peritonitis in a university hospital. Perit Dial Int 34:162–170

46.

Brown F, Liu WJ, Kotsanas D, Korman TM, Atkins RC (2007) A quarter of a century of adult peritoneal dialysis-related peritonitis at an Australian medical center. Perit Dial Int 27:565–574PubMed

47.

Rocha A, Rodrigues A, Teixeira L, Carvalho MJ, Mendonca D, Cabrita A (2012) Temporal trends in peritonitis rates, microbiology and outcomes: the major clinical complication of peritoneal dialysis. Blood Purif 33:284–291PubMedCrossRef

48.

Szabo SM, Gooch KL, Bibby MM, Vo PG, Mitchell I, Bradt P, Levy AR (2013) The risk of mortality among young children hospitalized for severe respiratory syncytial virus infection. Paediatr Respir Rev 13 [Suppl 2]:S1–S8PubMedCrossRef

49.

Chalmers JD, Rutherford J (2012) Can we use severity assessment tools to increase outpatient management of community-acquired pneumonia? Eur J Intern Med 23:398–406PubMedCrossRef

50.

Kvaerner KJ, Austeng ME, Abdelnoor M (2013) Hospitalization for acute otitis media as a useful marker for disease severity. Pediatr Infect Dis J 32:946–949PubMedCrossRef

Title: Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age
Authors: Danilo Lofaro
Judith L. Vogelzang
Karlijn J van Stralen
Kitty J. Jager
Jaap W. Groothoff
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Nephrology / Issue 2/2016
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-015-3209-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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