Date of Award

Spring 5-15-2020

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Dr. Lisa Casanova Ph.D.

Second Advisor

Dr. Jennifer Gander Ph.D.

Abstract

INTRODUCTION:

Although infections are a growing concern for patients undergoing dialysis (Karkar 2018), little current research has been done on the characteristics of dialysis patients who get an infection.

AIM:

The objective of this study is to investigate the patient characteristics associated with dialysis-related infections. Our secondary aim is to determine if these associations are modified by dialysis modality.

METHODS:

For this study, we linked data from the United States Renal Data System (USRDS) with Kaiser Permanente Georgia databases. To compare the covariates with the outcome variable of dialysis-related infection, we used a Bivariable Cox hazard ratio model. Descriptive baseline data are presented as mean±SD or median and interquartile range (IQR), as suitable. Baseline characteristics in PD and HD patients were compared by comparison testing, Kruskal-Wallis test, or chi-square proportion test.

RESULTS:

Our cohort of 3431 dialysis patients were 58.8% male and 41.2% female, 70.5% black and had an average age of 55.83 ±14.66. Among hemodialysis patients, the percentage of bacteremia infections (27.59%) was highest, where in peritoneal dialysis patients, the percentage of peritonitis infections (9.87%) was the highest. Bivariate analysis, using Cox’s Proportional Hazards Model, identified that the risk of infection while undergoing peritoneal dialysis (HR, 1.244; 95% CI, 1. 076-1.440) is greater than undergoing hemodialysis. When adding demographic variables to the model, the risk factors for contracting an infection are age (HR, 1.023; 95% CI, 1.018-1.027) and gender (HR, 1.194; 95% CI, 1.055-1.352).

DISCUSSION:

In this cohort, the risk factors identified for contracting an infection were peritoneal dialysis, age, and gender. This tells us that patients with these characteristics should exercise caution when undergoing dialysis and be informed of current infection control practices and the differences between modality options.

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