Cardiac valve replacement for infective endocarditis in patients with end stage renal disease on hemodialysis — A single institution experience

Ratna C. Medicherla, John Phair, Matthew Carnevale, William Jakobleff, Evan Lipsitz, Larry Scher

Research output: Contribution to journalArticle

Abstract

: Complications from vascular access are the leading cause of morbidity in the hemodialysis population. The use of tunneled catheters is associated with a greater risk of bacteremia and mortality when compared to other types of hemodialysis access. Infective endocarditis is a serious complication occurring in 2–5% of patients undergoing hemodialysis and is likely secondary to transient bacteremia from repetitive vascular access. Objective: To review outcomes in hemodialysis-dependent patients requiring cardiac valve replacement for infective endocarditis. Methods: A retrospective chart review was conducted to identify all patients who underwent valve replacement within a six-year period (January 2009–December 2014). Inclusion criteria included a diagnosis of infective endocarditis and end stage renal disease on hemodialysis. Relevant clinical information including demographics, comorbidities, valve involvement, causative organisms, and type of hemodialysis access (arteriovenous fistula, arteriovenous graft, or tunneled catheter) was collected. Results: A total of 1497 patients underwent cardiac valve replacement within the six-year period. Of these, 167 patients (11.2%) had infective endocarditis and 119 patients (7.9%) had end stage renal disease on hemodialysis. Overall 30-day mortality for valve replacement was 5.0% (75/1497). Mortality for patients with infective endocarditis was 7.2% (12/167) and for patients with end stage renal disease on hemodialysis was 10.1% (12/119). Thirty-three patients (2.2%) had infective endocarditis and end stage renal disease on hemodialysis. Of these, 12 patients were being dialyzed via arteriovenous fistula, 4 via arteriovenous graft, and 17 via tunneled catheter. Mortality occurred in 2 of 12 patients with arteriovenous fistula, 1 of 4 patients with arteriovenous graft, and 2 of 17 patients with tunneled catheter for an overall mortality of 15.2% (5/33). Conclusion: Infective endocarditis remains a significant problem in patients with end stage renal disease on hemodialysis, particularly when tunneled catheters are utilized for hemodialysis access. Although appropriate algorithms have been developed to minimize long term use of tunneled catheters, bacteremia remains a significant problem. We reviewed our institutional experience and the medical literature to determine outcomes in hemodialysis-dependent patients with infective endocarditis requiring valve replacement. Despite mortality rates between 42 and 73% reported in the literature, our mortality rate was 15.2%.1 Care of these critically ill patients must emphasize early diagnosis and aggressive management to optimize outcomes.

Original languageEnglish (US)
JournalVascular
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

Fingerprint

Heart Valves
Endocarditis
Chronic Kidney Failure
Renal Dialysis
Catheters
Mortality
Arteriovenous Fistula
Bacteremia
Transplants
Blood Vessels
Critical Illness

Keywords

  • arteriovenous access
  • cardiac valve replacement
  • end stage renal disease
  • hemodialysis
  • Infective endocarditis

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{ed2b9ff63b584e2faf7d8caf84e0f839,
title = "Cardiac valve replacement for infective endocarditis in patients with end stage renal disease on hemodialysis — A single institution experience",
abstract = ": Complications from vascular access are the leading cause of morbidity in the hemodialysis population. The use of tunneled catheters is associated with a greater risk of bacteremia and mortality when compared to other types of hemodialysis access. Infective endocarditis is a serious complication occurring in 2–5{\%} of patients undergoing hemodialysis and is likely secondary to transient bacteremia from repetitive vascular access. Objective: To review outcomes in hemodialysis-dependent patients requiring cardiac valve replacement for infective endocarditis. Methods: A retrospective chart review was conducted to identify all patients who underwent valve replacement within a six-year period (January 2009–December 2014). Inclusion criteria included a diagnosis of infective endocarditis and end stage renal disease on hemodialysis. Relevant clinical information including demographics, comorbidities, valve involvement, causative organisms, and type of hemodialysis access (arteriovenous fistula, arteriovenous graft, or tunneled catheter) was collected. Results: A total of 1497 patients underwent cardiac valve replacement within the six-year period. Of these, 167 patients (11.2{\%}) had infective endocarditis and 119 patients (7.9{\%}) had end stage renal disease on hemodialysis. Overall 30-day mortality for valve replacement was 5.0{\%} (75/1497). Mortality for patients with infective endocarditis was 7.2{\%} (12/167) and for patients with end stage renal disease on hemodialysis was 10.1{\%} (12/119). Thirty-three patients (2.2{\%}) had infective endocarditis and end stage renal disease on hemodialysis. Of these, 12 patients were being dialyzed via arteriovenous fistula, 4 via arteriovenous graft, and 17 via tunneled catheter. Mortality occurred in 2 of 12 patients with arteriovenous fistula, 1 of 4 patients with arteriovenous graft, and 2 of 17 patients with tunneled catheter for an overall mortality of 15.2{\%} (5/33). Conclusion: Infective endocarditis remains a significant problem in patients with end stage renal disease on hemodialysis, particularly when tunneled catheters are utilized for hemodialysis access. Although appropriate algorithms have been developed to minimize long term use of tunneled catheters, bacteremia remains a significant problem. We reviewed our institutional experience and the medical literature to determine outcomes in hemodialysis-dependent patients with infective endocarditis requiring valve replacement. Despite mortality rates between 42 and 73{\%} reported in the literature, our mortality rate was 15.2{\%}.1 Care of these critically ill patients must emphasize early diagnosis and aggressive management to optimize outcomes.",
keywords = "arteriovenous access, cardiac valve replacement, end stage renal disease, hemodialysis, Infective endocarditis",
author = "Medicherla, {Ratna C.} and John Phair and Matthew Carnevale and William Jakobleff and Evan Lipsitz and Larry Scher",
year = "2019",
month = "1",
day = "1",
doi = "10.1177/1708538119860024",
language = "English (US)",
journal = "Vascular",
issn = "1708-5381",
publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - Cardiac valve replacement for infective endocarditis in patients with end stage renal disease on hemodialysis — A single institution experience

AU - Medicherla, Ratna C.

AU - Phair, John

AU - Carnevale, Matthew

AU - Jakobleff, William

AU - Lipsitz, Evan

AU - Scher, Larry

PY - 2019/1/1

Y1 - 2019/1/1

N2 - : Complications from vascular access are the leading cause of morbidity in the hemodialysis population. The use of tunneled catheters is associated with a greater risk of bacteremia and mortality when compared to other types of hemodialysis access. Infective endocarditis is a serious complication occurring in 2–5% of patients undergoing hemodialysis and is likely secondary to transient bacteremia from repetitive vascular access. Objective: To review outcomes in hemodialysis-dependent patients requiring cardiac valve replacement for infective endocarditis. Methods: A retrospective chart review was conducted to identify all patients who underwent valve replacement within a six-year period (January 2009–December 2014). Inclusion criteria included a diagnosis of infective endocarditis and end stage renal disease on hemodialysis. Relevant clinical information including demographics, comorbidities, valve involvement, causative organisms, and type of hemodialysis access (arteriovenous fistula, arteriovenous graft, or tunneled catheter) was collected. Results: A total of 1497 patients underwent cardiac valve replacement within the six-year period. Of these, 167 patients (11.2%) had infective endocarditis and 119 patients (7.9%) had end stage renal disease on hemodialysis. Overall 30-day mortality for valve replacement was 5.0% (75/1497). Mortality for patients with infective endocarditis was 7.2% (12/167) and for patients with end stage renal disease on hemodialysis was 10.1% (12/119). Thirty-three patients (2.2%) had infective endocarditis and end stage renal disease on hemodialysis. Of these, 12 patients were being dialyzed via arteriovenous fistula, 4 via arteriovenous graft, and 17 via tunneled catheter. Mortality occurred in 2 of 12 patients with arteriovenous fistula, 1 of 4 patients with arteriovenous graft, and 2 of 17 patients with tunneled catheter for an overall mortality of 15.2% (5/33). Conclusion: Infective endocarditis remains a significant problem in patients with end stage renal disease on hemodialysis, particularly when tunneled catheters are utilized for hemodialysis access. Although appropriate algorithms have been developed to minimize long term use of tunneled catheters, bacteremia remains a significant problem. We reviewed our institutional experience and the medical literature to determine outcomes in hemodialysis-dependent patients with infective endocarditis requiring valve replacement. Despite mortality rates between 42 and 73% reported in the literature, our mortality rate was 15.2%.1 Care of these critically ill patients must emphasize early diagnosis and aggressive management to optimize outcomes.

AB - : Complications from vascular access are the leading cause of morbidity in the hemodialysis population. The use of tunneled catheters is associated with a greater risk of bacteremia and mortality when compared to other types of hemodialysis access. Infective endocarditis is a serious complication occurring in 2–5% of patients undergoing hemodialysis and is likely secondary to transient bacteremia from repetitive vascular access. Objective: To review outcomes in hemodialysis-dependent patients requiring cardiac valve replacement for infective endocarditis. Methods: A retrospective chart review was conducted to identify all patients who underwent valve replacement within a six-year period (January 2009–December 2014). Inclusion criteria included a diagnosis of infective endocarditis and end stage renal disease on hemodialysis. Relevant clinical information including demographics, comorbidities, valve involvement, causative organisms, and type of hemodialysis access (arteriovenous fistula, arteriovenous graft, or tunneled catheter) was collected. Results: A total of 1497 patients underwent cardiac valve replacement within the six-year period. Of these, 167 patients (11.2%) had infective endocarditis and 119 patients (7.9%) had end stage renal disease on hemodialysis. Overall 30-day mortality for valve replacement was 5.0% (75/1497). Mortality for patients with infective endocarditis was 7.2% (12/167) and for patients with end stage renal disease on hemodialysis was 10.1% (12/119). Thirty-three patients (2.2%) had infective endocarditis and end stage renal disease on hemodialysis. Of these, 12 patients were being dialyzed via arteriovenous fistula, 4 via arteriovenous graft, and 17 via tunneled catheter. Mortality occurred in 2 of 12 patients with arteriovenous fistula, 1 of 4 patients with arteriovenous graft, and 2 of 17 patients with tunneled catheter for an overall mortality of 15.2% (5/33). Conclusion: Infective endocarditis remains a significant problem in patients with end stage renal disease on hemodialysis, particularly when tunneled catheters are utilized for hemodialysis access. Although appropriate algorithms have been developed to minimize long term use of tunneled catheters, bacteremia remains a significant problem. We reviewed our institutional experience and the medical literature to determine outcomes in hemodialysis-dependent patients with infective endocarditis requiring valve replacement. Despite mortality rates between 42 and 73% reported in the literature, our mortality rate was 15.2%.1 Care of these critically ill patients must emphasize early diagnosis and aggressive management to optimize outcomes.

KW - arteriovenous access

KW - cardiac valve replacement

KW - end stage renal disease

KW - hemodialysis

KW - Infective endocarditis

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