芬兰开始透析患者感染相关死亡率的时间趋势和原因：一项全国性队列研究

IF 3.4 Q1 UROLOGY & NEPHROLOGY

Kidney Medicine Pub Date : 2025-04-18 DOI:10.1016/j.xkme.2025.101012

Susanna Kinnunen , Ilkka Helanterä , Auni Juutilainen , Wisam Bitar , Jaakko Helve , Patrik Finne

{"title":"芬兰开始透析患者感染相关死亡率的时间趋势和原因：一项全国性队列研究","authors":"Susanna Kinnunen , Ilkka Helanterä , Auni Juutilainen , Wisam Bitar , Jaakko Helve , Patrik Finne","doi":"10.1016/j.xkme.2025.101012","DOIUrl":null,"url":null,"abstract":"<div><h3>Rationale & Objective</h3><div>Previously, we reported a decrease in infection-related mortality in kidney transplant recipients. Regarding patients treated with dialysis, it is unclear whether infection-related mortality is decreasing. Therefore, we investigated current time trends and specific causes of infection-related mortality over 2 decades in a large cohort of patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>A nationwide cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients starting kidney replacement therapy were identified through the Finnish Registry for Kidney Diseases. Follow-up continued until death of any cause, kidney transplantation, moving abroad, recovery of kidney function, loss of follow-up, or end of study.</div></div><div><h3>Exposure</h3><div>Long-term kidney replacement therapy.</div></div><div><h3>Outcome</h3><div>Death due to infection.</div></div><div><h3>Analytical Approach</h3><div>Incidence rates, incidence rate ratios, and adjusted Cox regression hazard ratios for infection-related deaths were calculated by sub-cohorts consisting of patients whose kidney replacement therapy was started either 2000-2004, 2005-2009, 2010-2014, or 2015-2019. As sensitivity analyses, we studied infection-related mortality within 1 year of dialysis initiation and performed competing risk analysis.</div></div><div><h3>Results</h3><div>A total of 9,671 adult patients started long-term dialysis from 2000 to 2019. Infection-related deaths declined from 47 to 23 deaths per 1,000 person-years over the four 5-year intervals from 2000-2004 to 2015-2019. The hazard ratio of a Cox model including identified risk factors was 0.49 (95% CI, 0.39-0.62) for patients who started dialysis in 2015-2019 compared with those who started in 2000-2004. The most common specific causes of infection-related deaths were septicemia (38%), pulmonary infection (36%), and peritonitis (8%), whereas opportunistic infections rarely caused death.</div></div><div><h3>Limitations</h3><div>Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.</div></div><div><h3>Conclusions</h3><div>Risk of dying due to infections has halved since the beginning of the millennium despite aging among patients treated with dialysis. The reason for this development requires further studies.</div></div><div><h3>Plain Language Summary</h3><div>Patients treated with dialysis experience a very significantly increased risk of dying from infection compared to the general population. This study evaluated current time trends and specific causes of infectious disease mortality in patients treated with dialysis in Finland from 2000 to 2019 based on data from the national registry with complete coverage of the dialysis cohort. The risk of death from infection in maintenance dialysis in Finland has dropped by half since the 2000s, despite the aging and increased number of patients treated with dialysis. Sepsis, pneumonia, peritonitis, and common bacterial infections were the most frequent causes of infectious deaths in patients treated with dialysis. This period of study preceded the Covid-19 pandemic and provides a baseline for future comparison.</div></div>","PeriodicalId":17885,"journal":{"name":"Kidney Medicine","volume":"7 6","pages":"Article 101012"},"PeriodicalIF":3.4000,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study\",\"authors\":\"Susanna Kinnunen , Ilkka Helanterä , Auni Juutilainen , Wisam Bitar , Jaakko Helve , Patrik Finne\",\"doi\":\"10.1016/j.xkme.2025.101012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Rationale & Objective</h3><div>Previously, we reported a decrease in infection-related mortality in kidney transplant recipients. Regarding patients treated with dialysis, it is unclear whether infection-related mortality is decreasing. Therefore, we investigated current time trends and specific causes of infection-related mortality over 2 decades in a large cohort of patients treated with dialysis.</div></div><div><h3>Study Design</h3><div>A nationwide cohort study.</div></div><div><h3>Setting & Participants</h3><div>Patients starting kidney replacement therapy were identified through the Finnish Registry for Kidney Diseases. Follow-up continued until death of any cause, kidney transplantation, moving abroad, recovery of kidney function, loss of follow-up, or end of study.</div></div><div><h3>Exposure</h3><div>Long-term kidney replacement therapy.</div></div><div><h3>Outcome</h3><div>Death due to infection.</div></div><div><h3>Analytical Approach</h3><div>Incidence rates, incidence rate ratios, and adjusted Cox regression hazard ratios for infection-related deaths were calculated by sub-cohorts consisting of patients whose kidney replacement therapy was started either 2000-2004, 2005-2009, 2010-2014, or 2015-2019. As sensitivity analyses, we studied infection-related mortality within 1 year of dialysis initiation and performed competing risk analysis.</div></div><div><h3>Results</h3><div>A total of 9,671 adult patients started long-term dialysis from 2000 to 2019. Infection-related deaths declined from 47 to 23 deaths per 1,000 person-years over the four 5-year intervals from 2000-2004 to 2015-2019. The hazard ratio of a Cox model including identified risk factors was 0.49 (95% CI, 0.39-0.62) for patients who started dialysis in 2015-2019 compared with those who started in 2000-2004. The most common specific causes of infection-related deaths were septicemia (38%), pulmonary infection (36%), and peritonitis (8%), whereas opportunistic infections rarely caused death.</div></div><div><h3>Limitations</h3><div>Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.</div></div><div><h3>Conclusions</h3><div>Risk of dying due to infections has halved since the beginning of the millennium despite aging among patients treated with dialysis. The reason for this development requires further studies.</div></div><div><h3>Plain Language Summary</h3><div>Patients treated with dialysis experience a very significantly increased risk of dying from infection compared to the general population. This study evaluated current time trends and specific causes of infectious disease mortality in patients treated with dialysis in Finland from 2000 to 2019 based on data from the national registry with complete coverage of the dialysis cohort. The risk of death from infection in maintenance dialysis in Finland has dropped by half since the 2000s, despite the aging and increased number of patients treated with dialysis. Sepsis, pneumonia, peritonitis, and common bacterial infections were the most frequent causes of infectious deaths in patients treated with dialysis. This period of study preceded the Covid-19 pandemic and provides a baseline for future comparison.</div></div>\",\"PeriodicalId\":17885,\"journal\":{\"name\":\"Kidney Medicine\",\"volume\":\"7 6\",\"pages\":\"Article 101012\"},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2025-04-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Kidney Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2590059525000482\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Kidney Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590059525000482","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

基本原理及目的以前，我们报道了肾移植受者感染相关死亡率的下降。对于接受透析治疗的患者，感染相关死亡率是否正在下降尚不清楚。因此，我们调查了20多年来接受透析治疗的患者中感染相关死亡率的当前时间趋势和具体原因。研究设计：一项全国性队列研究。设置,通过芬兰肾脏疾病登记处确定开始肾脏替代治疗的参与者。随访一直持续到任何原因死亡、肾移植、移居国外、肾功能恢复、失去随访或研究结束。暴露长期肾脏替代治疗。结果：因感染死亡。通过由2000-2004年、2005-2009年、2010-2014年或2015-2019年开始肾脏替代治疗的患者组成的亚队列，计算感染相关死亡的发病率、发病率比和校正Cox回归风险比。作为敏感性分析，我们研究了透析开始后1年内感染相关的死亡率，并进行了竞争风险分析。结果2000 - 2019年，共有9671例成人患者开始长期透析。在2000-2004年至2015-2019年的4个5年间，与感染相关的死亡人数从每1000人年47人下降到23人。与2000-2004年开始透析的患者相比，2015-2019年开始透析的患者的Cox模型包括确定的危险因素的风险比为0.49 （95% CI, 0.39-0.62）。感染相关死亡最常见的具体原因是败血症（38%）、肺部感染（36%）和腹膜炎（8%），而机会性感染很少导致死亡。死亡证明对传染病的敏感性可能较低。死因只有一个。传染性死亡的类别可能重叠。结论：尽管接受透析治疗的患者年龄在增长，但自2000年以来，因感染而死亡的风险已经减少了一半。这种发展的原因需要进一步研究。与普通人群相比，接受透析治疗的患者死于感染的风险显著增加。本研究评估了2000年至2019年芬兰接受透析治疗的患者传染病死亡率的当前时间趋势和具体原因，基于透析队列完全覆盖的国家登记处的数据。自2000年代以来，芬兰维持性透析中感染死亡的风险下降了一半，尽管接受透析治疗的患者人数增加和老龄化。败血症、肺炎、腹膜炎和常见细菌感染是透析患者感染性死亡的最常见原因。这一时期的研究发生在Covid-19大流行之前，为未来的比较提供了基线。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study

Rationale & Objective

Previously, we reported a decrease in infection-related mortality in kidney transplant recipients. Regarding patients treated with dialysis, it is unclear whether infection-related mortality is decreasing. Therefore, we investigated current time trends and specific causes of infection-related mortality over 2 decades in a large cohort of patients treated with dialysis.

Study Design

A nationwide cohort study.

Setting & Participants

Patients starting kidney replacement therapy were identified through the Finnish Registry for Kidney Diseases. Follow-up continued until death of any cause, kidney transplantation, moving abroad, recovery of kidney function, loss of follow-up, or end of study.

Exposure

Long-term kidney replacement therapy.

Outcome

Death due to infection.

Analytical Approach

Incidence rates, incidence rate ratios, and adjusted Cox regression hazard ratios for infection-related deaths were calculated by sub-cohorts consisting of patients whose kidney replacement therapy was started either 2000-2004, 2005-2009, 2010-2014, or 2015-2019. As sensitivity analyses, we studied infection-related mortality within 1 year of dialysis initiation and performed competing risk analysis.

Results

A total of 9,671 adult patients started long-term dialysis from 2000 to 2019. Infection-related deaths declined from 47 to 23 deaths per 1,000 person-years over the four 5-year intervals from 2000-2004 to 2015-2019. The hazard ratio of a Cox model including identified risk factors was 0.49 (95% CI, 0.39-0.62) for patients who started dialysis in 2015-2019 compared with those who started in 2000-2004. The most common specific causes of infection-related deaths were septicemia (38%), pulmonary infection (36%), and peritonitis (8%), whereas opportunistic infections rarely caused death.

Limitations

Death certificates may have low sensitivity for infectious diseases. Only one cause of death is available. Categories of infectious deaths may overlap.

Conclusions

Risk of dying due to infections has halved since the beginning of the millennium despite aging among patients treated with dialysis. The reason for this development requires further studies.

Plain Language Summary

Patients treated with dialysis experience a very significantly increased risk of dying from infection compared to the general population. This study evaluated current time trends and specific causes of infectious disease mortality in patients treated with dialysis in Finland from 2000 to 2019 based on data from the national registry with complete coverage of the dialysis cohort. The risk of death from infection in maintenance dialysis in Finland has dropped by half since the 2000s, despite the aging and increased number of patients treated with dialysis. Sepsis, pneumonia, peritonitis, and common bacterial infections were the most frequent causes of infectious deaths in patients treated with dialysis. This period of study preceded the Covid-19 pandemic and provides a baseline for future comparison.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊