No difference in survival with tissue valve in dialysis patients with endocarditis

Infective endocarditis in patients with chronic kidney disease undergoing long term hemodialysis has high mortality. A recent retrospective analysis of United States Renal Data System published in Circulation assessed those who had bacterial endocarditis between 2004 and 2007 [Leither MD et al. Long-term Survival of Dialysis Patients With Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States. Circulation. 2013;128:344-351]. During this period, nearly one thousand three hundred of over eleven thousand dialysis patients hospitalized with bacterial endocarditis underwent valve replacement. While a little over forty four percent of them received tissue valve, a little less than fifty six percent received non tissue valves. Estimated survival at one year was forty eight percent with tissue valve and fifty percent with non tissue valve. In two thirds of cases, Staphylococcus was the predominant organism identified.
Independent predictors of mortality in those undergoing valve replacement were:
1) Older age
2) Diabetic kidney disease
3) Surgery during index hospitalization
4) Staphylococcal infection
5) Dysrhythmias

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