Patient characteristics and prognostic importance of dialysis in IE - a nationwide study

Jeppe K Petersen; Lauge Østergaard; Peter L Graversen; Katra Hadji-Turdeghal; Anna Stahl; Amna Alhakak; Jacob Eifer Møller; Niels Eske Bruun; Jonas A Povlsen; Claus Moser; Morten Smerup; Jannik Helweg-Larsen; Daniel Faurholt-Jepsen; Henning Bundgaard; Kasper Iversen; Lars Køber; Emil Fosbøl

doi:10.1016/j.ahj.2026.107435

Patient characteristics and prognostic importance of dialysis in IE - a nationwide study

Jeppe K Petersen^*
, Lauge Østergaard
, Peter L Graversen
, Katra Hadji-Turdeghal
, Anna Stahl
, Amna Alhakak
, Jacob Eifer Møller
, Niels Eske Bruun
, Jonas A Povlsen
, Claus Moser
, Morten Smerup
, Jannik Helweg-Larsen
, Daniel Faurholt-Jepsen
, Henning Bundgaard
, Kasper Iversen
, Lars Køber
, Emil Fosbøl

^*Corresponding author for this work

Cardiology

Research output: Contribution to journal › Article › Research › peer-review

Abstract

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.

Original language	English
Article number	107435
Number of pages	10
Journal	American heart journal
Volume	298
Early online date	30 Mar 2026
DOIs	https://doi.org/10.1016/j.ahj.2026.107435
Publication status	Published - Aug 2026

Keywords

Infective endocarditis
Outcomes
Risk
Prognosis
Humans
Risk Factors
Middle Aged
Endocarditis/complications
Male
Hospital Mortality/trends
Acute Kidney Injury/therapy
Denmark/epidemiology
Renal Dialysis/statistics & numerical data
Aged, 80 and over
Female
Registries
Aged

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10.1016/j.ahj.2026.107435

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Petersen, J. K., Østergaard, L., Graversen, P. L., Hadji-Turdeghal, K., Stahl, A., Alhakak, A., Møller, J. E., Bruun, N. E., Povlsen, J. A., Moser, C., Smerup, M., Helweg-Larsen, J., Faurholt-Jepsen, D., Bundgaard, H., Iversen, K., Køber, L., & Fosbøl, E. (2026). Patient characteristics and prognostic importance of dialysis in IE - a nationwide study. American heart journal, 298, Article 107435. https://doi.org/10.1016/j.ahj.2026.107435

@article{7600281771d341a89def8e0948581604,

title = "Patient characteristics and prognostic importance of dialysis in IE - a nationwide study",

abstract = "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.",

keywords = "Infective endocarditis, Outcomes, Risk, Prognosis, Humans, Risk Factors, Middle Aged, Endocarditis/complications, Male, Hospital Mortality/trends, Acute Kidney Injury/therapy, Denmark/epidemiology, Renal Dialysis/statistics \& numerical data, Aged, 80 and over, Female, Registries, Aged",

author = "Petersen, \{Jeppe K\} and Lauge {\O}stergaard and Graversen, \{Peter L\} and Katra Hadji-Turdeghal and Anna Stahl and Amna Alhakak and M{\o}ller, \{Jacob Eifer\} and Bruun, \{Niels Eske\} and Povlsen, \{Jonas A\} and Claus Moser and Morten Smerup and Jannik Helweg-Larsen and Daniel Faurholt-Jepsen and Henning Bundgaard and Kasper Iversen and Lars K{\o}ber and Emil Fosb{\o}l",

year = "2026",

month = aug,

doi = "10.1016/j.ahj.2026.107435",

language = "English",

volume = "298",

journal = "American heart journal",

issn = "0002-8703",

publisher = "Elsevier",

}

Petersen, JK, Østergaard, L, Graversen, PL, Hadji-Turdeghal, K, Stahl, A, Alhakak, A, Møller, JE, Bruun, NE, Povlsen, JA, Moser, C, Smerup, M, Helweg-Larsen, J, Faurholt-Jepsen, D, Bundgaard, H, Iversen, K, Køber, L & Fosbøl, E 2026, 'Patient characteristics and prognostic importance of dialysis in IE - a nationwide study', American heart journal, vol. 298, 107435. https://doi.org/10.1016/j.ahj.2026.107435

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

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 -

Patient characteristics and prognostic importance of dialysis in IE - a nationwide study

Abstract

Keywords

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