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Access‐related Infection and Pre‐infection Albumin in Hemodialysis
Author(s) -
Adeniyi OA,
Tzamaloukas AH
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01263.x
Subject(s) - hypoalbuminemia , medicine , odds ratio , hemodialysis , confidence interval , albumin , serum albumin , logistic regression , gastroenterology , immunology
Infection of hemodialysis (HD) access is a major cause of morbidity and mortality. Certain conditions predisposing to infection (malnutrition, chronic inflammation) are associated with hypoalbuminemia. To test whether pre‐existing hypoalbuminemia has any relationship with HD access infections, we analyzed the records of 87 patients on chronic HD who had access‐related infection as the reason for hospital admission between July 1999 and June 2001. We obtained data on age, gender, pre‐infection albumin levels, co‐morbidities, complications, type of infection, infecting organism, mode of management and mortality. We compared average pre‐infection albumin levels of 79 patients with access infection with those of 198 control patients on chronic HD during the study period without documented access infection. We also compared mortalities between patients with HD tunneled catheter infection treated with antibiotics alone and those treated with antibiotics plus access removal. The mean pre‐infection serum albumin was lower in subjects with access infection than those without access infection (2.4 ± 0.6 vs. 3.2 ± 0.6 g/dL, P < 0.0001). Logistic regression including several clinical confounders among its candidate variables identified hypoalbuminemia as a strong predictor (P < 0.0001) of access infection. The odds ratio (OR) of access infection increased progressively with decreasing pre‐infection serum albumin: OR of access infection was 8.0 (95% confidence interval {CI} 4.5–16.6) for albumin ≤ 3.0 g/L, 11.0 (95% CI 4.4–22.3) for albumin ≤ 2.5 g/dL, and 27.9 (95% CI 6.1–128.1) for albumin ≤ 2.0 g/dL. Women had a marginally higher chance of tunneled HD catheter infection than men (P = 0.08). Case mortality was 25%(4 in 16) in patients with tunneled HD catheter infection treated with antibiotics alone and 2.8%(2 in 71) in those treated with antibiotics plus access removal or change over a guide wire (P = 0.0096). Hypoalbuminemia, a predictor of adverse outcomes in HD, is associated with an increased risk of HD access infection. Women with tunneled HD catheter have a tendency to higher rates of access infection than men. Treatment of tunneled HD catheter infection with antibiotics alone is associated with increased risk of death.