High level of infection-related hospitalizations in the 2019-2020 French national dialysis cohort.

Abstract

Background: Dialysis patients experience a high rate of hospitalizations for infection. This work aimed to study the frequency of hospitalizations for infections and the associated risk factors in a nationwide dialysis cohort during 2019-2020.

Methods: This was an observational, retrospective study using two national databases. We included 59 585 patients undergoing dialysis from 1 January 2019 to 31 December 2020. Hospitalization rates (per 1000 patient-years) were calculated from all hospital discharges with a principal or related diagnosis of infection. Infections were classified into 14 categories. The association between individual risk factors and incidence of infection-related hospitalizations was estimated with multilevel Poisson models with patients as random effects.

Results: The incidence rate was 245 (95% confidence intervals (CI) 242-249) hospitalizations per 1000 patient-years, 241 (236-246) and 249 (244-254) in 2019 and 2020. After excluding COVID-19-related hospitalizations, the 2020 incidence was 197 (192-201). The main source of infection-related hospitalizations was pulmonary [93 (91-96)] followed by sepsis [33 (32-34)], digestive excluding peritonitis [25 (24-26)], cutaneous [24 (23-26)], urinary [18 (17-19)], and osteoarticular [9 (8-9)]. Except for pulmonary infection lower in 2020, attributed to barrier measures and lockdowns, there were no major discrepancies in incidence between 2019 and 2020. The main factors associated with risk of infection were male gender; low albumin level; presence of diabetes, chronic respiratory failure, heart failure, and lower-limb arteritis; cirrhosis stage; walking disability; and presence of active cancer. The risk of infection-related hospitalization was increased for patients with tunneled catheters and arteriovenous grafts and those under peritoneal dialysis compared with patients with arteriovenous fistula [1.63 (95% CI 1.52-1.76), 1.30 (1.11-1.53) and 1.73 (1.53-1.96); all P < .001].

Conclusion: The risk of hospitalization for infection is high in dialysis patients, which calls for intensified prevention measures. Lockdown and shielding barriers were efficient to decrease the incidence of pulmonary infections but not other infections.