CLINICAL, MICROBIOLOGICAL CHARACTERISTICS AND IN-HOSPITAL OUTCOMES OF PNEUMONIA IN END-STAGE KIDNEY DISEASE PATIENTS ON CHRONIC HEMODIALYSIS

Abstract

Background: Pneumonia is a common infection among patients with end-stage kidney disease (ESKD) on chronic hemodialysis (CHD).

Objectives: (1) To describe the clinical, paraclinical characteristics and in-hospital outcomes, and (2) the microbiological profile of pneumonia in ESKD patients on CHD.

Methods: A descriptive cross-sectional study with in-hospital follow-up.

Results: We enrolled 91 ESKD patients on CHD hospitalized for pneumonia. The sampled median age was 59 years, with 57 females (62.6%). The median dialysis vintage year was 3 years. Vascular access types included arteriovenous fistula in 77.0% and catheter in 23.1%. All patients had hypertension, 77% heart failure and 35.2% diabetes mellitus. The most common symptoms of pneumonia were dyspnea and coughing, whereas 31.9% with productive cough and only 5.5% with fever. The most common chest X-ray finding was a combination of alveolar and interstitial infiltrates (50%), and 65% had pleural effusion. Median leukocyte count was 8.6 G/L, C-reactive protein (CRP) was 47.1 mg/L. The percentage of high-quality sputum samples for culture was low (27/91 patients, 29.7%). 81.3% cases didn’t present the causative microorganisms. Candida spp. was the most common pathogen (44%), followed by Gram-positive bacteria (28%) and Gram-negative bacteria (28%). The median length of hospital stay was 7 days, and the in-hospital mortality rate was 22%.

Conclusions: Pneumonia in ESKD patients on CHD presented with atypical clinical and laboratory features, and was associated with high in-hospital mortality. Identifying the causative pathogen was challenging, and required the combination of cultures from sputum and other specimens.

Keywords: pneumonia; end-stage kidney disease; chronic hemodialysis