TY - JOUR
T1 - Patient characteristics and prognostic importance of dialysis in IE - a nationwide study
AU - Petersen, Jeppe K
AU - Østergaard, Lauge
AU - Graversen, Peter L
AU - Hadji-Turdeghal, Katra
AU - Stahl, Anna
AU - Alhakak, Amna
AU - Møller, Jacob Eifer
AU - Bruun, Niels Eske
AU - Povlsen, Jonas A
AU - Moser, Claus
AU - Smerup, Morten
AU - Helweg-Larsen, Jannik
AU - Faurholt-Jepsen, Daniel
AU - Bundgaard, Henning
AU - Iversen, Kasper
AU - Køber, Lars
AU - Fosbøl, Emil
N1 - Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.
PY - 2026/8
Y1 - 2026/8
N2 - BACKGROUND: Acute kidney injury (AKI) requiring dialysis is a serious complication of infective endocarditis (IE), yet detailed data on risk factors and outcomes are limited.METHODS: Using the nationwide NIDUS registry, we identified all dialysis-naive patients hospitalized with first-time left-sided IE in Denmark from 2016 to 2021. Patients were grouped by whether they developed dialysis-requiring AKI. Factors associated with dialysis were assessed with multivariable logistic regression. In-hospital and post-discharge mortality were evaluated using Kaplan-Meier methods and multivariable Cox models.RESULTS: Among 2,738 patients with left-sided IE, 203 (7%) received dialysis for AKI (70% male; median age 70 years) and 2,535 (93%) did not (66% male; median age 75 years). Those requiring dialysis had greater comorbidity, and more frequently underwent valvular surgery (57.0% vs 19.8%, P< .01), with two-thirds initiating dialysis postoperatively. Independent factors associated with initiation of dialysis included chronic kidney disease, diabetes, liver disease, sepsis, valvular surgery, and infection with Staphylococcus aureus or Enterococcus species. In-hospital mortality was substantially higher among patients requiring dialysis (37.9 vs 16.5%; HR 1.86, 95% CI 1.39-2.50). In-hospital mortality was higher with dialysis (37.9% vs 16.5%; HR 1.86, 95% CI 1.39-2.50). Among survivors, associated mortality was higher within 3 months (12.0% vs 9.0%; HR 2.35, 95% CI 1.30-4.27) but similar from 3 to 12 months (6.3% vs 11.3%; HR 0.89, 95% CI: 0.41-1.93).CONCLUSION: Patients initiating dialysis during IE had an increased burden of traditional risk factors for AKI-with valve surgery representing the strongest associated risk factor for initiating dialysis. Patients initiating dialysis during IE had a markedly higher in-hospital mortality. Among survivors, higher associated mortality was confined to the early post-discharge period and diminished after 3 months.
AB - BACKGROUND: Acute kidney injury (AKI) requiring dialysis is a serious complication of infective endocarditis (IE), yet detailed data on risk factors and outcomes are limited.METHODS: Using the nationwide NIDUS registry, we identified all dialysis-naive patients hospitalized with first-time left-sided IE in Denmark from 2016 to 2021. Patients were grouped by whether they developed dialysis-requiring AKI. Factors associated with dialysis were assessed with multivariable logistic regression. In-hospital and post-discharge mortality were evaluated using Kaplan-Meier methods and multivariable Cox models.RESULTS: Among 2,738 patients with left-sided IE, 203 (7%) received dialysis for AKI (70% male; median age 70 years) and 2,535 (93%) did not (66% male; median age 75 years). Those requiring dialysis had greater comorbidity, and more frequently underwent valvular surgery (57.0% vs 19.8%, P< .01), with two-thirds initiating dialysis postoperatively. Independent factors associated with initiation of dialysis included chronic kidney disease, diabetes, liver disease, sepsis, valvular surgery, and infection with Staphylococcus aureus or Enterococcus species. In-hospital mortality was substantially higher among patients requiring dialysis (37.9 vs 16.5%; HR 1.86, 95% CI 1.39-2.50). In-hospital mortality was higher with dialysis (37.9% vs 16.5%; HR 1.86, 95% CI 1.39-2.50). Among survivors, associated mortality was higher within 3 months (12.0% vs 9.0%; HR 2.35, 95% CI 1.30-4.27) but similar from 3 to 12 months (6.3% vs 11.3%; HR 0.89, 95% CI: 0.41-1.93).CONCLUSION: Patients initiating dialysis during IE had an increased burden of traditional risk factors for AKI-with valve surgery representing the strongest associated risk factor for initiating dialysis. Patients initiating dialysis during IE had a markedly higher in-hospital mortality. Among survivors, higher associated mortality was confined to the early post-discharge period and diminished after 3 months.
KW - Infective endocarditis
KW - Outcomes
KW - Risk
KW - Prognosis
KW - Humans
KW - Risk Factors
KW - Middle Aged
KW - Endocarditis/complications
KW - Male
KW - Hospital Mortality/trends
KW - Acute Kidney Injury/therapy
KW - Denmark/epidemiology
KW - Renal Dialysis/statistics & numerical data
KW - Aged, 80 and over
KW - Female
KW - Registries
KW - Aged
U2 - 10.1016/j.ahj.2026.107435
DO - 10.1016/j.ahj.2026.107435
M3 - Article
C2 - 41921587
SN - 0002-8703
VL - 298
JO - American heart journal
JF - American heart journal
M1 - 107435
ER -