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Comparison of the clinical features and outcomes of infective endocarditis between hemodialysis and non-hemodialysis patients

Authors Hsiao CC, Weng CH, Li YJ, Wu HH, Chen YC, Chen YM, Hsu HH, Tian YC

Received 21 February 2017

Accepted for publication 11 April 2017

Published 24 May 2017 Volume 2017:13 Pages 663—668

DOI https://doi.org/10.2147/TCRM.S135262

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Hoa Le

Peer reviewer comments 2

Editor who approved publication: Professor Deyun Wang

Ching-Chung Hsiao,1,* Cheng-Hao Weng,1,2,* Yi-Jung Li,1 Hsin-Hsu Wu,1,2 Yung-Chang Chen,1 Yu-Ming Chen,1 Hsiang-Hao Hsu,1 Ya-Chung Tian1

1Kidney Research Center and Department of Nephrology, Chang Gung Memorial Hospital, Taipei, 2Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan

*These authors contributed equally to this work

Abstract: Hemodialysis (HD) patients are more susceptible to infective endocarditis (IE) due to the increased risk of bacterial invasion through intravascular access. However, it remains unclear whether the causative organisms and outcomes of IE in HD patients differ from those in non-HD patients. This study clarified the differences in clinical presentation and outcomes between HD and non-HD patients. At our hospital, we performed a retrospective study of 39 HD and 51 non-HD patients with echocardiography-confirmed IE between June 2000 and February 2007. No differences in sex, intravenous drug use, previous diagnosis of congestive heart failure, and previous valvular surgery were observed between these two groups. The number of patients with diabetic mellitus in these two groups was significantly different (28.2% HD vs 5.9% non-HD patients). The C-reactive protein levels in the two groups were not significantly different. By contrast, the erythrocyte sedimentation rate was significantly higher in the HD patients (HD vs non-HD: 87.2±33.32 vs 52.96±28.19). The incidence of IE involving the mitral valve (MV; 45.1%) or the aortic valve (AV; 43.1%) was similar among the non-HD patients, whereas a preference of IE involving the MV (79.5%) over the AV (15.4%) was noted among the HD patients. The HD patients had a significantly higher Staphylococcus aureus infection rate (HD: 46.2%; non-HD: 27.5%). The proportion of methicillin-resistant S. aureus (MRSA; 83.8%) infection accounting for S. aureus IE in the HD group was higher than that (28.6%) in the non-HD group. The in-hospital mortality rate did not differ between the two groups. In conclusion, compared with non-HD patients, a propensity of IE involving the MV and a higher MRSA infection rate were observed in HD patients. The in-hospital mortality rate of echocardiography-confirmed IE did not differ between the two groups.

Keywords: infective endocarditis, hemodialysis, mitral valve, aortic valve, Staphylococcus aureus

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