MAJOR ARTICLE e232 • CID 2021:72 (1 May) • Petersen et al Clinical Infectious Diseases Received 27 March 2020; editorial decision 16 June 2020; published online 20 July 2020. Correspondence: J. K. Petersen, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark (jeppekp3008@gmail.com). Clinical Infectious Diseases ® 2021;72(9):e232–9 © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. DOI: 10.1093/cid/ciaa1017 Outcome of Dialysis-Requiring Acute Kidney Injury in Patients With Infective Endocarditis: A Nationwide Study Jeppe Kofoed Petersen, 1 Andreas Dalsgaard Jensen, 1 Niels Eske Bruun, 2,3 Anne-Lise Kamper, 4 Jawad Haider Butt, 1 Eva Havers-Borgersen, 1 Mavish S Chaudry, 5 Christian Torp-Pedersen, 6 Lars Køber, 1 Emil Loldrup Fosbøl, 1 and Lauge Østergaard 1 1 Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark, 2 Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Zealand, Denmark, 3 Clinical Institutes, Copenhagen and Aalborg Universities, Denmark, 4 Department of Nephrology, Rigshospitalet, Copenhagen, Denmark, 5 Department of Cardiology, Herlev-Gentofte Hospital University of Copenhagen, Copenhagen, Denmark, and 6 Department of Cardiology and Epidemiology, Nordsjaellands Hospital, Hillerød, Denmark Background. Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subse- quent reversibility are sparse. Methods. Using Danish nationwide registries, we identifed patients with frst-time IE from 2000 to 2017. Dialysis-naïve pa- tients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed 1 year postdischarge. Multivariable adjusted Cox proportional hazard analysis was used to examine 1-year mortality for patients surviving IE according to use of dialysis. Results. We included 7307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more ofen underwent cardiac valve surgery compared with nondialysis patients (47.4% vs 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n = 197), 153 (77.7%) initiated dialysis on or afer the date of surgery. Te in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (P < .0001). Of those who started dialysis and survived hospitalization, 21.6% continued dialysis treatment within 1 year afer discharge. In multivariable adjusted analysis, dialysis during admission with IE was associated with an increased 1-year mortality from IE dis- charge, hazard ratio = 1.64 (95% confdence interval, 1.21–2.23). Conclusion. In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identifed a high-risk group with an in-hospital mortality of 40% and an approximate 20% risk of continued dialysis. Tose with dialysis during admission with IE showed worse long-term outcomes than those without. Infective endocarditis (IE) is a clinically heterogeneous infec- tious disease with an incidence of 3–10 per 100 000 person- years [1–3], and several studies have found an increase in the incidence of IE during the past 2 decades [4–10]. Although rare, IE is characterized by increased morbidity and mortality, with an in-hospital mortality of approximately 20% [1, 6, 8, 11–14]. Prognosis is further aggravated when IE is accompanied by extracardiac manifestations—one being acute kidney injury (AKI) that appears in 6%–30% of patients with IE [2, 3, 11, 15–18]. In severe cases of AKI, dialysis treatment may be required [1, 3, 17]. A multicenter Chinese study and a single-center French study have shown that in a cohort of patients with IE, 8.2% and 9.9% of patients required dialysis treatment during the hos- pitalization for IE. In both studies, dialysis was found to be associated with an increased mortality risk [17, 19]. However, the relation between AKI onset and treatment with dialysis in patients with IE is yet to be further elucidated; the few studies examining initiation of dialysis in patients with IE had a lim- ited study population and were conducted in selected patient cohorts from tertiary centers. In general, data on the short- and long-term outcome in pa- tients initiating dialysis during admission with IE are sparse. Also, little is known about risk factors associated with initiation of dialysis in patients with IE [11]. To increase the knowledge on the prognosis of IE for pa- tients with use of dialysis and associated complications, unsel- ected nationwide data are warranted. Using Danish nationwide registries, we aimed to examine the temporary and permanent consequences of treatment with dialysis in patients hospitalized with IE. METHODS Data Sources A unique personal identifier allows for linkage between ad- ministrative Danish registries on a nationwide basis [20, 21]. The National Population Registry, The Danish National Patient Registry (DNPR), The National Prescription Registry, Downloaded from https://academic.oup.com/cid/article/72/9/e232/5873732 by guest on 06 June 2022