Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States
Infection-related hospitalization rates in pediatric versus adult patients with end-stage renal disease in the United States
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DOI：
10.1681/asn.2006040406
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发表时间：
2007-03-01
影响因子：
13.6
通讯作者：
Collins, Allan J.
中科院分区：
文献类型：
--
作者：
Chavers, Blanche M.;Solid, Craig A.;Collins, Allan J.
感染是终末期肾病患者发病和死亡的常见原因。1996年至2001年，比较了美国联邦医疗保险事件中儿童和成人透析和移植患者在发病后3年内的感染相关住院(IH)发生率：血液透析(HD)患者(儿童n=1469；成人n=305,323)；腹膜透析(PD)患者(儿童n=982；成人n=27,119)和肾移植(KTX)患者(儿童n=1108；成人n=31,663)。根据主要诊断代码确定IH；根据索赔数据计算IH累积发病率和发病率。1996年至2001年间，发生终末期肾病的儿童患者在36个月内发生高血压的累积发生率在HD组为39.9%，PD组为51.2%，KTX组为47.4%(HD或PD组与KTX组，P<；0.0001)。成人HD、PD和KTX患者的累积发病率分别为52.6%、51.8%和39.8%(HD或PD与KTX相比，P<；0.0001)。儿童KTX患者和成人HD患者(调整后比率分别为1.53与HD和1.9与PD，P<；0.001)和成人HD患者(调整后比率分别为1.20与KTX和1.11与PD，P<；0.001)每1000患者月的IH发生率最高。在发病的前36个月内，与HD和PD患者相比，儿童KTX患者的IH发生率最高，而成人ESRD患者的结果则相反。儿童KTX患者需要在移植后进行感染监测。
Infection is a common cause of morbidity and mortality in patients with ESRD. Infection-related hospitalization (IH) incidence among US Medicare incident pediatric and adult dialysis and transplant patients within 3 yr of presentation was compared from 1996 to 2001: Hemodialysis (HD) patients (pediatric n = 1469; adult n = 305,323); peritoneal dialysis (PD) patients (pediatric n = 982; adult n = 27,119), and kidney transplant (KTx) patients (pediatric n = 1108; adult n = 31,663). IH were identified from principal diagnosis codes; IH cumulative incidence and rates were calculated from claims data. Cumulative incidence of IH at 36 mo for incident pediatric patients with ESRD during 1996 to 2001 was 39.9% in HD, 51.2% in PD, and 47.4% in KTx patients (HD or PD versus KTx, P < 0.0001). Cumulative incidence for adults was 52.6% in HD, 51.8% in PD, and 39.8% in KTx patients (HD or PD versus KTx, P < 0.0001). IH rates per 1000 patient-months were highest for pediatric KTx patients (adjusted rate ratio 1.53 versus HD and 1.90 versus PD, P < 0.001 for each) and adult HD patients (adjusted rate ratio 1.20 versus KTx and 1.11 versus PD, P < 0.001 for each). Within the first 36 mo of incidence, IH rates are highest for incident pediatric KTx patients compared with HD and PD patients, in contrast to findings for adult patients with ESRD. Pediatric KTx patients require infection surveillance after transplantation.