Epidemiologic features and long-term outcome of dialysis patients with infective endocarditis in Taiwan

The incidence of infective endocarditis (IE) is high in dialysis patients. Limited data are available on the risk factors for IE and long-term outcome after IE in dialysis patients, especially in Asian populations.

We used Taiwan National Health Insurance Research Database to design a longitudinal cohort study. 68,426 ESRD patients who began dialysis between 1999 and 2007 were included. The follow-up period was from the start of dialysis to death, end of dialysis, or end of 2008. Cox proportional hazards models were used to identify the risk factors for IE.

IE was diagnosed in 502 patients during follow-up (201.4 per 100,000 person-years). Diabetes mellitus (DM), congestive heart failure (CHF), cerebro-vascular accident (CVA), and rheumatic heart disease (RHD) (HR: 3.07, 95% CI: 1.99-4.75) were associated with an increasing risk of development of IE. The cumulative incidence rate of IE in patients with RHD was 1.4, 2.2, and 3.9% at 1, 3, and 5 years. In-hospital mortality was 23.5%. Cumulative survival rates post-IE were 54.3% at 1 year and only 35.3% at 5 years.

Dialysis patients had a higher risk of IE. Those who were older and had DM, CHF, CVA, or especially RHD were at a greater risk. Dialysis patients with IE also had high mortality.