Article Figures & Data
Figures
Figure 1. Adjusted rates of hospitalization with septicemia in the first year of dialysis therapy. (A) Hemodialysis patients. (B) Peritoneal dialysis patients. For the years 1991 to 1995, rates are adjusted for the baseline age, gender, race, and Hispanic ethnicity. For the years after 1995, rates are adjusted for age, gender, race, Hispanic ethnicity, congestive heart failure, atherosclerotic heart disease, cardiac arrest or dysrhythmia, stroke or transient ischemic attack, peripheral vascular disease, chronic obstructive pulmonary disease, current tobacco use, cancer, alcohol or drug dependence, inability to ambulate or transfer, hemoglobin value, serum albumin value, estimated GFR, and body mass index. For 1991 to 1995, P < 0.0001 for incident year in hemodialysis, P = 0.002 for incident year in peritoneal dialysis, and P < 0.0001 for the comparison of hemodialysis patients and peritoneal dialysis patients. For 1996 to 1999, P = 0.02 for incident year in hemodialysis, P = 0.02 for incident year in peritoneal dialysis, and P < 0.0001 for the comparison of hemodialysis patients and peritoneal dialysis patients.
Figure 2. Interval Poisson model of adjusted mortality rates in 1996 to 1999 patients, with and without an admission for septicemia in the first year of dialysis therapy. Adjustment was made for the baseline variables shown in Table 2. P < 0.0001 for mortality rate comparisons in patients with and without septicemia. For illustration, the adjusted mortality rates after first admission with myocardial infarction (MI), congestive heart failure (CHF), stroke, and peripheral vascular disease (PVD) are also shown.
Figure 3. Interval Poisson model of cardiovascular (CV) event rates in 1996 to 1999 patients. (A) Myocardial infarction (MI) and congestive heart failure (CHF), with and without an admission for septicemia. (B) Cerebrovascular accident (CVA) and peripheral vascular disease (PVD), with and without an admission for septicemia. Adjustment was made for the baseline variables shown in Table 2. P < 0.0001 for comparisons in patients with and without septicemia for each event.
Tables
Table 1. Baseline characteristics 1991 to 1995, comparing those included and those excluded because Medicare was not the sole, primary payera
Dialysis Inception 1991 to 1995 Included (%; n = 197,095) Excluded (%; n = 69,245) Pb Odds Ratio for Exclusionc 95% CIc Pc a CI, confidence interval. b Using the χ2 test. c Using a multiple logistic regression model including the variables shown in the first column. The reference categories were peritoneal dialysis, age 20 to 44 yr, male gender, other race, non-Hispanic ethnicity, and 1991 as year of dialysis inception. d Age data were missing in 0.007% of patients and 0.049% of excluded individuals. Mode of dialysis <0.0001 hemodialysis 85.6 80.5 0.88 0.86 to 0.90 <0.0001 peritoneal dialysis 14.4 19.6 1 — — Age, yd <0.0001 0 to 19 0.9 2.0 1.29 1.20 to 1.39 <0.0001 20 to 44 15.0 25.9 1 — — 45 to 64 30.0 50.2 0.93 0.91 to 0.96 <0.0001 65 to 74 33.1 14.7 0.23 0.23 to 0.24 <0.0001 ≥75 21.0 7.2 0.17 0.17 to 0.18 <0.0001 Gender <0.0001 male 54.2 57.4 1 — — female 45.8 42.6 0.94 0.93 to 0.96 <0.0001 Race <0.0001 white 61.7 64.5 1.23 1.16 to 1.31 <0.0001 black 33.6 28.7 0.75 0.71 to 0.80 <0.0001 Asian 2.6 4.4 1.79 1.65 to 1.93 <0.0001 other 2.2 2.4 1 — — Hispanic ethnicity <0.0001 yes 5.2 4.8 0.60 0.58 to 0.63 <0.0001 no 94.8 95.2 1 — — Year of dialysis inception <0.0001 1991 17.8 15.2 1 — — 1992 19.5 16.4 1.01 0.98 to 1.04 0.6 1993 19.8 17.3 1.08 1.05 to 1.12 <0.0001 1994 20.7 24.3 1.47 1.43 to 1.52 <0.0001 1995 22.2 26.8 1.54 1.49 to 1.58 <0.0001 Table 2. Baseline characteristics 1996 to 1999, comparing those included and those excluded because Medicare was not the sole, primary payer
Dialysis Inception 1996 to 1999 Included (%; n = 196,356) Excluded (%; n = 96,076) Pa Odds Ratio for Exclusionb 95% CIb Pb a Using the χ2 test. b Using a multiple logistic regression model including the variables shown in the first column. The reference categories were peritoneal dialysis; age 20 to 44 yr; male gender; other race; non-Hispanic ethnicity; 1996 as year of dialysis inception; absence of congestive heart failure, atherosclerotic heart disease, cardiac arrest or dysrhythmia, stroke or transient ischemic attack, peripheral vascular disease, chronic obstructive pulmonary disease, current tobacco use, cancer, alcohol or drug dependence, inability to ambulate or transfer; hemoglobin 11 to 12 g/dl; serum albumin 3.1 to 3.4 g/dl; estimated GFR 5.1 to 10 ml/min per 1.73 m2; and body mass index 18.5 to 24.9 kg/m2. c Age data were missing in 0.007% of patients and 0.008% of excluded individuals. Mode of dialysis <0.0001 hemodialysis 89.6 86.0 0.92 0.90 to 0.94 <0.0001 peritoneal dialysis 10.4 14.0 1 — — Age (yr)c <0.0001 0 to 19 0.8 2.0 1.47 1.37 to 1.57 <0.0001 20 to 44 13.2 21.6 1 — — 45 to 64 30.7 47.4 0.98 0.96 to 1.00 0.07 65 to 74 30.6 17.7 0.36 0.35 to 0.37 <0.0001 ≥75 24.7 11.4 0.28 0.27 to 0.29 <0.0001 Gender <0.0001 male 52.9 54.9 female 47.1 45.1 0.96 0.95 to 0.98 <0.0001 Race <0.0001 1 — — white 61.4 60.6 0.93 0.89 to 0.97 0.001 black 32.1 30.4 0.70 0.67 to 0.74 <0.0001 Asian 3.1 4.6 1.26 1.18 to 1.33 <0.0001 other 3.4 4.4 — — Hispanic ethnicity <0.0001 yes 11.5 12.8 0.89 0.87 to 0.91 <0.0001 no 88.5 87.2 1 — — Year of dialysis inception <0.0001 1996 23.5 21.3 1 — — 1997 24.2 24.2 1.13 1.10 to 1.16 <0.0001 1998 25.5 26.2 1.18 1.15 to 1.21 <0.0001 1999 26.8 28.2 1.22 1.19 to 1.24 <0.0001 Congestive heart failure 34.1 26.1 <0.0001 0.91 <0.0001 Atherosclerotic heart disease 27.3 20.4 <0.0001 0.95 0.93 to 0.97 <0.0001 Cardiac arrest or dysrhythmia 6.6 4.5 <0.0001 0.97 0.94 to 1.01 0.1 Stroke or transient ischemic attack 9.5 6.7 <0.0001 0.87 0.84 to 0.90 <0.0001 Peripheral vascular disease 15.3 11.3 <0.0001 0.91 0.88 to 0.93 <0.0001 Diabetes 46.7 44.2 <0.0001 0.92 0.91 to 0.94 <0.0001 Chronic obstructive pulmonary disease 7.4 4.9 <0.0001 0.90 0.87 to 0.93 <0.0001 Current tobacco use 5.6 5.2 <0.0001 0.78 0.75 to 0.81 <0.0001 Cancer 5.0 4.0 <0.0001 1.00 0.96 to 1.04 1.00 Alcohol or drug dependence 2.3 2.5 <0.0001 0.91 0.87 to 0.96 0.0009 Inability to ambulate or transfer 4.3 3.1 <0.0001 0.96 0.91 to 1.00 0.05 Hemoglobin (g/dl) <0.0001 missing 6.3 5.0 0.77 0.74 to 0.81 <0.0001 <11 76.3 76.2 0.92 0.90 to 0.94 <0.0001 11 to 12 10.9 11.5 1 — — >12 6.6 7.4 1.04 1.00 to 1.08 0.05 Serum albumin (g/dl) <0.0001 missing 22.6 21.6 1.01 0.99 to 1.04 0.4 ≤3.0 30.8 30.0 0.98 0.96 to 1.01 0.1 3.1 to 3.4 19.0 18.0 1 — — ≥3.5 27.7 30.4 1.08 1.05 to 1.11 <0.0001 Estimated GFR (ml/min per 1.73 m2) <0.0001 missing 2.5 1.7 0.67 0.63 to 0.71 <0.0001 ≤5.0 16.8 20.1 1.01 0.99 to 1.03 0.6 5.1 to 10.0 56.9 58.0 1 — — >10.0 23.8 20.2 0.94 0.92 to 0.96 <0.0001 Body mass index (kg/m2) <0.0001 missing 2.9 2.2 0.78 0.73 to 0.82 <0.0001 <18.5 6.6 6.0 0.95 0.92 to 0.98 0.004 18.5 to 24.9 42.1 40.1 1 — — 25 to 29.9 26.7 27.3 1.01 0.99 to 1.03 0.2 ≥30 21.7 24.4 0.99 0.97 to 1.01 0.4 Table 3. Associations between baseline characteristics and septicemia hospitalization in the first year of dialysis therapy in the 1996-to-1999 cohort
Factor Relative Riska 95% CIa,b Pa a Using a Poisson regression model including the variables shown in the first column. The reference categories were peritoneal dialysis; age 20 to 44 yr; male gender; other race; non-Hispanic ethnicity; 1996 as year of dialysis inception; absence of congestive heart failure, atherosclerotic heart disease, cardiac arrest or dysrhythmia, stroke or transient ischemic attack, peripheral vascular disease, chronic obstructive pulmonary disease, current tobacco use, cancer, alcohol or drug dependence, inability to ambulate or transfer; hemoglobin 11 to 12 g/dl; serum albumin 3.1 to 3.4 g/dl; estimated GFR 5.1 to 10 ml/min per 1.73 m2; and body mass index 18.5 to 24.9 kg/m2. Mode of dialysis hemodialysis 2.09 1.97 to 2.22 <0.0001 peritoneal dialysis 1 — — Age (yr) 0 to 19 0.71 0.59 to 0.86 0.0003 20 to 44 1 — — 54 to 64 0.85 0.81 to 0.89 <0.0001 65 to 74 1.02 0.98 to 1.07 0.4 ≥75 1.21 1.15 to 1.26 <0.0001 Gender male 1 — — female 1.02 0.99 to 1.05 0.09 Race white 0.97 0.90 to 1.03 0.3 black 1.07 0.99 to 1.14 0.06 Asian 0.61 0.55 to 0.68 <0.0001 other 1 — — Hispanic ethnicity 1.09 1.05 to 1.13 <0.0001 Congestive heart failure 1.14 1.11 to 1.18 <0.0001 Atherosclerotic heart disease 0.98 0.95 to 1.01 0.1 Cardiac arrest or dysrhythmia 1.02 0.97 to 1.07 0.5 Stroke or transient ischemic attack 1.16 1.11 to 1.21 <0.0001 Peripheral vascular disease 1.11 1.08 to 1.15 <0.0001 Diabetes 1.11 1.08 to 1.14 <0.0001 Chronic obstructive pulmonary disease 1.09 1.05 to 1.15 <0.0001 Current tobacco use 0.95 0.90 to 1.00 0.06 Cancer 1.20 1.14 to 1.27 <0.0001 Alcohol or drug dependence 1.18 1.09 to 1.28 <0.0001 Inability to ambulate or transfer 1.65 1.57 to 1.73 <0.0001 Hemoglobin (g/dl) <11 1.05 1.01 to 1.09 0.03 11 to 12 1 — — >12 0.99 0.93 to 1.06 0.9 Serum albumin (g/dl) ≤3.0 1.24 1.20 to 1.28 <0.0001 3.1 to 3.4 1 — — ≥3.5 0.84 0.80 to 0.87 <0.0001 Estimated GFR (ml/min per 1.73 m2) <5 0.89 0.86 to 0.93 <0.0001 5 to 10 1 — — >10 1.22 1.19 to 1.26 <0.0001 Body mass index (kg/m2) <18.5 1.18 1.13 to 1.24 <0.0001 18.5 to 24.9 1 — — 25 to 29.9 0.95 0.92 to 0.98 0.0007 ≥30 1.01 0.97 to 1.04 0.68
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