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 cau...
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Elsevier
2025-06-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059525000482 |
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| author | Susanna Kinnunen Ilkka Helanterä Auni Juutilainen Wisam Bitar Jaakko Helve Patrik Finne |
| author_facet | Susanna Kinnunen Ilkka Helanterä Auni Juutilainen Wisam Bitar Jaakko Helve Patrik Finne |
| author_sort | Susanna Kinnunen |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-647eafe6ffbb4958ac2a2f5becf85f5b |
| institution | OA Journals |
| issn | 2590-0595 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | Kidney Medicine |
| spelling | doaj-art-647eafe6ffbb4958ac2a2f5becf85f5b2025-08-20T01:52:23ZengElsevierKidney Medicine2590-05952025-06-017610101210.1016/j.xkme.2025.101012Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort StudySusanna Kinnunen0Ilkka Helanterä1Auni Juutilainen2Wisam Bitar3Jaakko Helve4Patrik Finne5Division of Nephrology, Department of Medicine, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland; Address for Correspondence: Susanna Kinnunen, MD, Kuopio University Hospital, PB 100,70029 KYS, Finland.Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, FinlandInstitute of Clinical Medicine/Internal Medicine, University of Eastern Finland, Kuopio, FinlandDepartment of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, FinlandDepartment of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Finnish Registry for Kidney Diseases, Finnish Kidney and Liver Association, Helsinki, FinlandDepartment of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, FinlandRationale & 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.http://www.sciencedirect.com/science/article/pii/S2590059525000482Dialysishemodialysisincidence rateincidence rate ratioinfection-related mortalitykidney replacement therapy |
| spellingShingle | Susanna Kinnunen Ilkka Helanterä Auni Juutilainen Wisam Bitar Jaakko Helve Patrik Finne Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study Kidney Medicine Dialysis hemodialysis incidence rate incidence rate ratio infection-related mortality kidney replacement therapy |
| title | Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study |
| title_full | Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study |
| title_fullStr | Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study |
| title_full_unstemmed | Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study |
| title_short | Time Trends and Causes of Infection-Related Mortality Among Patients Starting Dialysis in Finland: A Nationwide Cohort Study |
| title_sort | time trends and causes of infection related mortality among patients starting dialysis in finland a nationwide cohort study |
| topic | Dialysis hemodialysis incidence rate incidence rate ratio infection-related mortality kidney replacement therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2590059525000482 |
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