Infective endocarditis in haemodialysis patients: results from a Brazilian cohort study
J Barros Becker, C H Fischer, V Ambrosio Moises, D A BarbosaAbstract
Background
Individuals with chronic kidney disease (CKD) on haemodialysis (HD) have a higher risk of infective endocarditis (IE) and worse outcomes. Currently, approximately 140,000 Brazilians undergo haemodialysis (HD), yet few national studies address the epidemiology and prognosis of infective endocarditis in this population (1,2).
Purpose
This study aimed to analyze the epidemiology, clinical characteristics, and mortality risk factors of CKD patients on haemodialysis with IE at a Brazilian tertiary hospital.
Methods
Retrospective cohort study, conducted at our hospital with data collected from January 2009 to December 2024. CKD patients on HD, over 18 years old, hospitalized with IE according to the modified Duke criteria and complete data in medical records, were included. Participants were categorized into two groups based on outcomes, survival or death, for comparative analysis.
Results
A total of 117 patients were included. The in-hospital mortality was 37.6%. Most (88%) received dialysis with a central venous catheter; 47.9% had recent hospitalizations. Staphylococcus aureus was the main causative agent, followed by coagulase-negative staphylococci (CoNS). The mitral valve was the most affected, especially in the death outcome (p<0.001). Patients who died had higher mean age and experienced more complications during hospitalization, such as surgical treatment, intensive care unit admission, stroke, and septic shock (p<0.001). Stroke was identified as an independent risk factor for in-hospital mortality (Odds Ratio [OR] 75.156; p = 0.05).
Conclusions
In-hospital mortality was high, reaching 37.6%. Staphylococcus aureus was the main causative agent. Patients with death outcome were older and had more complications during hospital stay. Stroke was an independent risk factor for in-hospital mortality. A high prevalence of central venous catheters use for haemodialysis was observed, which may have contributed to increased vulnerability to infectious complications, such as infective endocarditis.