Etiology of bacterial septicemia in chronic dialysis patients in the United States

Aims: Previous studies have identified risk factors for and mortality assoc iated with hospitalized septicemia (septicemia) in patients with end-stage renal disease (ESRD). However, the etiologies of septicemia in this populat ion have not been determined. Methods: 327,993 patients in the United State s Renal Data System initiated on ESRD therapy between January 1, 1992, and June 30, 1997, who never received renal transplants were analyzed in a retr ospective registry study of hospitalized cases of septicemia (ICD9 038.x). Results: Of the study population, 43,441 (13.2%) had septicemia. In logisti c regression analysis, septicemia was associated with female gender, Africa n American race, ESRD due to diabetes and obstruction/chronic pyelonephriti s, increased age, and hemodialysis (vs. peritoneal dialysis). Polycystic ki dney disease and glomerulonephritis were associated with decreased risk of septicemia. At initiation of dialysis, higher hemoglobin, and lower weight, creatinine, and albumin were associated with septicemia. Among patients wi th septicemia, the leading specified etiologies were Staphylococcus (34%) a nd miscellaneous Gramnegative rods (21.7%). Etiologies of septicemia were s ignificantly associated with hemodialysis (Gram-positives and Pneumococcus) , female gender (Gram-negatives except Pseudomonas), African American race (Staphylococcus), and diabetes (global). Hemodialysis (vs. peritoneal dialy sis) and Staphylococcus as an etiology of septicemia were associated with r epeated hospitalizations for septicemia. Septicemia was independently assoc iated with patient mortality, and African Americans and females with septic emia were at disproportionately greater risk of mortality. Conclusions: Thi s study identifies significant associations between septicemia and female g ender, African American race, hemodialysis, and higher hemoglobin. Signific ant associations between etiologies of septicemia and patient subgroups are also identified.