• Arteriovenous fistula maturation
• Central venous catheter
• Central venous oxygen saturation
• Hemodialysis
• Upper body blood flow
• Vascular access

• Humans
• Middle Aged
• Male
• Female
• Renal Dialysis/methods
• Arteriovenous Shunt, Surgical/methods
• Aged
• Time Factors
• Oxygen Saturation

• antimicrobial treatment
• empiric antibiotic treatment
• end-stage renal disease
• epidural abscess
• hemodialysis
• infective spondylodiscitis

• Blood stream Infection
• Hemodialysis
• Mortality

• Humans
• Male
• Middle Aged
• Aged
• Aged, 80 and over
• Female
• Renal Dialysis/adverse effects
• Renal Dialysis/methods
• Retrospective Studies
• Bacteremia/epidemiology
• Bacteremia/etiology
• Sepsis/complications
• Gram-Negative Bacteria
• Anti-Bacterial Agents/therapeutic use
• Risk Factors

Emerging data suggest that sodium disarrays including hyponatremia are potential risk factors for infection ensuing from impairments in host immunity, which may be exacerbated by coexisting conditions (i.e. mucosal membrane and cellular edema leading to breakdown of microbial barrier function). While dysnatremia and infection-related mortality are common in dialysis patients, little is known about the association between serum sodium levels and the risk of bloodstream infection in this population.

Among 823 dialysis patients from the national Biospecimen Registry Grant Program who underwent serum sodium testing over the period January 2008–December 2014, we examined the relationship between baseline serum sodium levels and subsequent rate of bloodstream infection. Bloodstream infection events were directly ascertained using laboratory blood culture data. Associations between serum sodium level and the incidence of bloodstream infection were estimated using expanded case mix–adjusted Poisson regression models.

In the overall cohort, ∼10% of all patients experienced one or more bloodstream infection events during the follow-up period. Patients with both lower sodium levels <134 mEq/l and higher sodium levels ≥140 mEq/l had higher incident rate ratios (IRRs) of bloodstream infection in expanded case mix analyses (reference 136–<138 mEq/l), with adjusted IRRs of 2.30 [95% confidence interval (CI) 1.19–4.44], 0.77 (95% CI 0.32–1.84), 1.39 (95% CI 0.78–2.47), 1.88 (95% CI 1.08–3.28) and 1.96 (95% CI 1.08–3.55) for sodium levels <134, 134–<136, 138–<140, 140–<142 and ≥142 Eq/l, respectively.

Both lower and higher baseline serum sodium levels were associated with a higher rate of subsequent bloodstream infections in dialysis patients. Further studies are needed to determine whether correction of dysnatremia ameliorates infection risk in this population.

• nephrology
• epidemiology

• COVID-19/epidemiology
• COVID-19 Testing
• Humans
• Kidney Diseases
• Pandemics/prevention & control
• SARS-CoV-2

Angiotensin-converting enzyme 2 (ACE2) works as an endogenous counter-regulator of the renin-angiotensin system, which has pivotal roles in preventing both cardiovascular disease (CVD) and inflammation. In general populations, higher plasma soluble ACE2 levels were reported to be associated with increased risks of all-cause death and major CVD. Because infections are fatal in patients on maintenance hemodialysis, we aimed to explore whether soluble ACE2 levels are associated with an increased risk of infection-related hospitalization in these patients.

Using data from a prospective, multicenter, cohort study conducted in Tokyo, Japan, we performed a post-hoc analyses of 724 clinically stable patients on maintenance hemodialysis. We measured baseline serum soluble ACE2 levels and assessed potential determinants of its with infection-related hospitalization as a primary outcome as well as all-cause death and CVD as secondary outcomes using a Cox proportional hazards model.

The soluble ACE2 level (median, 0.16 ng/ml; interquartile range, 0.07–0.57 ng/ml) showed a weak negative association with age. During a median follow-up of 39 months, 106 patients (14.6%) were hospitalized with infectious diseases. Compared with the lower half of soluble ACE2 levels, the higher half was associated with an increased risk of infection-related hospitalization (hazard ratio, 1.57; 95% confidence interval, 1.02–2.41) with adjustment by other risk factors. On the other hand, there were no significant associations between soluble ACE2 and risks of all-cause death and CVD.

Higher soluble ACE2 levels may associate with an increased risk of infection-related hospitalization in patients on maintenance hemodialysis.

• all-cause death
• angiotensin-converting enzyme 2
• infection
• maintenance hemodialysis
• soluble ACE2

• geriatric nutritional risk index (GNRI)
• hemodialysis
• hospitalization
• infection
• mortality
• protein-energy wasting (PEW)

• dialysis
• infection control
• nephrology
• qualitative research

• Humans
• Multicenter Studies as Topic
• Povidone-Iodine/therapeutic use
• Randomized Controlled Trials as Topic
• Renal Dialysis
• Sepsis
• Staphylococcal Infections/prevention & control
• Staphylococcus aureus

• R01 HS026724 AHRQ HHS
• UL1 TR002537 NCATS NIH HHS
• National Center For Advancing Translational Sciences of the National Institutes of Health
• 3M
• Agency for Health Research and Quality (AHRQ)

• Chronic
• Hospital Costs
• Medicaid
• Medicare
• Outpatients
• Palliative Care
• Patient Care Planning
• Patient Readmission
• Renal Insufficiency
• chronic kidney disease
• hospitalization
• kidney failure
• rehospitalization

• Cardiovascular Diseases/complications
• Catheterization/adverse effects
• Humans
• Infections/complications
• Insurance, Health, Reimbursement
• Interdisciplinary Communication
• Kidney Failure, Chronic/complications
• Kidney Failure, Chronic/therapy
• Medicare
• Palliative Care
• Patient Care Planning
• Patient Care Team
• Patient Discharge
• Patient Readmission
• Renal Dialysis
• Risk Assessment
• Risk Factors
• United States

Diabetes mellitus is a known risk factor for infection. Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients.

This is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabetic patients between 1 January 2002 and 31 December 2013 were included. Primary outcomes analyzed were patient emergency room (ER) infection events and deaths.

After propensity score matching, there were 337,184 patients in both the P4P and non-P4P cohort. The results showed that patients’ completing one-year P4P program was associated with a decreased risk of any ER infection event (27.2% vs. 29%; subdistribution hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.86–0.88). While the number needed to treat was 58 for the non-P4P group, it dropped to 28 in the P4P group. The risk of infection-related death was significantly lower in the P4P group than in the non-P4P group (4.1% vs. 7.6%; HR 0.46, 95% CI 0.45–0.47). The effect of P4P on ER infection incidence and infection-related death was more apparent in the subgroups of patients who were female, had diabetes duration ≥5 years, chronic kidney disease, higher Charlson’s Comorbidity Index scores and infection-related hospitalization in the previous 3 years.

The P4P program might reduce risk of ER infection events and infection-related deaths in type 2 diabetic patients.

The online version contains supplementary material available at 10.1186/s12913-021-06091-2.

• Diabetes
• Infection
• Mortality
• Pay-for-performance
• Sepsis

Infection is the second leading cause of death in patients undergoing long-term dialysis. Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) when compared with hemodialysis. In this study, we investigated the influence of IRH on clinical outcomes in incident PD patients.

In total, 583 incident PD patients were selected from the Clinical Research Center Registry for End-Stage Renal Disease, a nationwide multicenter prospective observational cohort study in Korea. Incident PD patients who had been hospitalized for infection-related diseases were defined as the IRH group. The primary outcome was all-cause mortality and the secondary outcome was technical failure. The median follow-up period was 29 months.

Seventy-three PD patients (12.5%) were categorized in the IRH group. Multivariable logistic regression analysis showed that diabetes mellitus was a significant independent predictor for IRH (odds ratio, 2.43; 95% confidence interval [CI], 1.12 to 5.29; P = 0.007). The most common causes of IRH were peritonitis (63.0%) and respiratory tract infection (9.6%). Multivariable Cox proportional hazard model analysis showed that IRH was a significant independent risk factor for all-cause mortality (hazard ratio [HR], 2.51; 95% CI, 1.12 to 5.62; P = 0.026) and for the technical failure of PD (HR, 3.23; 95% CI, 1.90 to 5.51; P < 0.001).

Our data showed that after initiation of PD, IRH was significantly associated with higher risk of all-cause mortality and technical failure.

• Hospitalization
• Infections
• Mortality
• Peritoneal dialysis
• Peritonitis

• Infection
• Peritoneal dialysis
• Peritonitis
• Serum albumin
• Transitioning

It remains unclear whether infection events before entering end stage renal disease (ESRD) have a long-term negative impact on patients with advanced chronic kidney disease (CKD) who survive to permanent dialysis. We enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis between January 1, 2004 and December 31, 2013. We used multivariable Cox as well as Fine and Gray models to determine the association of pre-dialysis infection exposure with all-cause mortality after starting dialysis. Compared with no infection during advanced CKD, the presence of infection exposure during that period was independently associated with a higher risk of all-cause mortality in the first year of dialysis (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.27–1.42) and also during the entire follow-up period (HR 1.19, 95% CI 1.16–1.22). The increased risks of all-cause mortality increased incrementally with higher annual number of infections during advanced CKD. Similar results were found for all other adverse outcomes, e.g. post-ESRD infection-related hospitalization and major cardiac and cerebrovascular events. In conclusion, infection events during advanced CKD was associated with increased risks of adverse outcomes after dialysis has been started. Timely interventions in such a vulnerable group may help attenuate these risks.

• Hospitalization
• Hyperalbuminemia
• Hypoalbuminemia
• Incident dialysis patients
• Protein energy wasting

Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.

• Catheter-related blood stream infection
• end-stage renal disease
• hemodialysis
• internal jugular vein catheter
• non-pharmacological intervention

• Arteriovenous fistula
• Central venous catheter
• End-stage renal disease
• Infection control
• Intravenous antibiotic start
• Vascular site infection

• Hospitalization
• prevalence
• risk factors

• Central Venous Catheters
• Economic Impact
• Insurance Coverage
• Insurance, Health
• Kidney Failure, Chronic
• Medicaid
• Medically Uninsured
• Medicare
• Odds Ratio
• Registries
• Retrospective Studies
• Risk
• United States Renal Data System
• arteriovenous fistula
• clinical epidemiology
• hemodialysis access
• hospitalization
• renal dialysis

• Aged
• Central Venous Catheters/economics
• Cohort Studies
• Female
• Humans
• Insurance, Health/statistics & numerical data
• Kidney Failure, Chronic/economics
• Kidney Failure, Chronic/therapy
• Male
• Medicaid
• Medicare
• Middle Aged
• Renal Dialysis/economics
• Retrospective Studies
• Time Factors
• United States

• K23 DK101693 NIDDK NIH HHS
• K24 DK085446 NIDDK NIH HHS
• K08 DK118213 NIDDK NIH HHS
• T32 DK007357 NIDDK NIH HHS
• F32 DK107123 NIDDK NIH HHS

• Cardiovascular disease
• Estimated glomerular filtration rate (eGFR)
• Hospitalization
• Infection
• Mortality

• Adult
• Aged
• Aged, 80 and over
• Cardiovascular Diseases/mortality
• Cause of Death
• China/epidemiology
• Cohort Studies
• Creatinine/blood
• Electronic Health Records
• Female
• Glomerular Filtration Rate
• Hospitalization/statistics & numerical data
• Humans
• Infections/complications
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Renal Insufficiency/physiopathology

Antibiotic resistance is a major global health threat. High prevalences of colonization and infection with multi-drug resistance organisms (MDROs) have been reported in patients undergoing dialysis. It is unknown if this finding extends to patients with mild and moderate/severe kidney disease. An observational study included all adult incident patients hospitalized with a discharge diagnosis of infection in four hospitals from Guangzhou, China. Inclusion criteria: Serum creatinine measurement at admission together with microbial culture confirmed infections. Exclusion criterion: Undergoing renal replacement therapy. Four categories of Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) were compared: eGFR ≥ 105, 60–104 (reference), 30–59, and <30 ml/min/1.73 m². The odds ratio of MDROs, defined as specific pathogens (Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp.) resistant to three or more antibiotic classes, were calculated using a multivariable logistic regression model across eGFR strata. Of 94,445 total microbial culture records, 7,288 first positive cultures matched to infection diagnosis were selected. Among them, 5,028 (68.9%) were potential MDROs. The odds of infections by MDROs was 19% and 41% higher in those with eGFR between 30–59 ml/min/1.73 m² (Adjusted odds ratio, AOR): 1.19, 95% CI:1.02–1.38, P = 0.022) and eGFR < 30 ml/min/1.73 m² (AOR: 1.41, 95% CI:1.12–1.78, P = 0.004), respectively. Patients with impaired renal function have a higher risk of infections by MDROs. Kidney dysfunction at admission may be an indicator for need of closer attention to microbial culture results requiring subsequent change of antibiotics.

Both dialysis facilities and hospitals are accountable for 30-day hospital readmissions among U.S. hemodialysis patients. We examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions.

In a retrospective cohort comprised of electronic medical record (EMR) data linked with national registry data, we identified unique patient index admissions (n = 1056; 2/1/10–7/31/15) that were followed by ≥3 in-center hemodialysis sessions within 10 days, among patients treated at 19 Southeastern dialysis facilities. Indicators of processes of care were defined as present vs. absent in the dialysis facility EMR. Readmissions were defined as admissions within 30 days of the index discharge; pulmonary edema-related vs. other readmissions defined by discharge codes for pulmonary edema, fluid overload, and/or congestive heart failure. Multinomial logistic regression to estimate odds ratios (ORs) for pulmonary edema-related and other vs. no readmissions.

Overall, 17.7% of patients were readmitted, and 8.0% had pulmonary edema-related readmissions (44.9% of all readmissions). Documentation of the index admission (OR = 2.03, 95% CI 1.07–3.85), congestive heart failure (OR = 1.87, 95% CI 1.07–3.27), and home medications stopped (OR = 1.81, 95% CI 1.08–3.05) or changed (OR = 1.69, 95% CI 1.06–2.70) in the EMR post-hospitalization were all associated with higher risk of pulmonary edema-related vs. no readmission; lower post-dialysis weight (by ≥0.5 kg) after vs. before hospitalization was associated with 40% lower risk (OR = 0.60, 95% CI 0.37–0.96).

Our results suggest that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.

The online version of this article (10.1186/s12882-018-0983-5) contains supplementary material, which is available to authorized users.

• Dialysis
• Fluid overload
• Pulmonary edema
• Readmission
• Rehospitalization

People with end‐stage renal disease (ESRD) are at risk for advanced heart failure, but little is known about use and outcomes of durable mechanical circulatory support in this setting. We examined use and outcomes of implantable ventricular assist devices (VADs) in a national ESRD cohort.

We performed a retrospective cohort study of Medicare beneficiaries with ESRD who underwent implantable VAD placement from 2006 to 2014. We examined in‐hospital and 1‐year mortality, all‐cause and cause‐specific hospitalizations, and heart/kidney transplantation outcomes. We investigated as predictors demographic factors, time‐period of VAD implantation, primary or post‐cardiotomy implantation, and duration of ESRD before VAD implantation. We identified 96 people with ESRD who underwent implantable VAD placement. At time of VAD implantation, 74 (77.1%) were receiving hemodialysis, 10 (10.4%) were receiving peritoneal dialysis and 12 (12.5%) had renal transplant. Time from incident ESRD to VAD implantation was median 4.0 (interquartile range 1.1, 8.2) years. Mortality during the implantation hospitalization was 40.6%. Within 1 year of implantation 61.5% of people had died. On multivariable analysis, males had half the mortality risk of females. Lower mortality risk was also seen with VAD implantation in a primary setting, and with more recent year of implantation, but these results did not reach statistical significance.

Medicare beneficiaries with ESRD are undergoing durable VAD implantation, often several years after incident ESRD, although in low numbers. Mortality is high among these patients, highlighting the need for investigations to improve treatment selection and management.

• end‐stage renal disease
• kidney
• ventricular assist device

• Bacteremia
• Emergency department
• Febrile
• Fever
• Hemodialysis
• Sepsis

Hospitalization for cardiovascular disease (CVD) is common among patients receiving maintenance dialysis, but patterns of readmissions following cardiovascular events are underexplored.

In this retrospective analysis of prevalent, Medicare‐eligible patients receiving dialysis in 2012–2013, all live‐discharge hospitalizations attributed to CVD were ascertained. Rates of all‐cause, CVD‐related, and non–CVD‐related readmissions and death in the ensuing 10 and 30 days were calculated. Multinomial logistic modeling was used to assess the relationship between potential explanatory factors and outcomes of interest. Among 142 210 analyzed hospitalizations, mean age at time of index CVD hospitalization was 64.9±14.1 years; 50.4% of index hospitalizations were for women, and 41.4% were for white patients. Fully 15.6% and 34.2% of CVD hospitalizations resulted in readmission within 10 and 30 days, respectively; less than half of readmissions were CVD related (42.5%, 10 days; 43.1%, 30 days). Death within 30 days, regardless of readmission, occurred after 4.5% of index hospitalizations; 51.2% were attributed to CVD. Compared with ages 65 to 69 years, younger age tended to be associated with increased readmission risk (adjusted relative risk for ages 18–44 years: 1.55; 95% confidence interval, 1.48–1.63). Readmission risk did not differ between white and black patients, but risk of death without readmission was markedly lower for black patients (relative risk: 0.60; 95% confidence interval, 0.55–0.67).

Roughly 1 in 3 CVD hospitalizations resulted in 30‐day readmission; nearly 1 in 20 was followed by death within 30 days. Risk of death without readmission was higher for white than black patients, despite no difference in risk of readmission.

• cardiovascular events
• dialysis
• rehospitalization

• Aged
• Aged, 80 and over
• China
• Critical Care/statistics & numerical data
• Electronic Health Records/statistics & numerical data
• Facilities and Services Utilization
• Female
• Health Care Costs/statistics & numerical data
• Hospitals
• Humans
• Infections/complications
• Length of Stay
• Male
• Middle Aged
• Renal Insufficiency, Chronic/mortality
• Renal Insufficiency, Chronic/pathology
• Survival Analysis
• Treatment Outcome

Infectious diseases are the second highest cause of death in patients on dialysis. In addition, testosterone deficiency or hypogonadism is prevalent in dialysis patients. However, to our knowledge, no studies have investigated the association between testosterone levels and infectious events. We aimed to evaluate whether serum testosterone levels are associated with infection-related hospitalization in male hemodialysis patients in a prospective cohort study.

We divided the study population into 3 groups based on serum testosterone levels. Associations between testosterone levels and clinical outcomes of infection-related hospitalization, all-cause mortality, and cardiovascular disease (CVD) events were analyzed using the Cox proportional hazard model.

Nine hundred two male patients were enrolled and followed up for a median of 24.7 months. Their mean ± SD age was 63.4 ± 11.8 years, and their median (interquartile range) of total testosterone was 11.7 nmol/l (7.9–14.9 nmol/l). During follow-up, 123 participants died. Infection-related hospitalization and CVD events occurred in 116 and 151 patients, respectively. Infection-related hospitalization was more frequent in the lower testosterone tertile than in the higher testosterone tertile (hazard ratio [HR]: 2.12; 95% confidence interval [CI]: 1.18–3.79; P = 0.01) in adjusted models. Moreover, all-cause mortality was significantly greater in the lower testosterone tertile than in the higher testosterone tertile in adjusted analysis (HR: 2.26; 95% CI: 1.21–4.23; P = 0.01). In contrast, there were no significant differences in CVD events by testosterone level.

Low levels of testosterone may be associated with higher rates of infection-related hospitalization and all-cause mortality in male hemodialysis patients.

• hemodialysis
• infection
• mortality

• Centers for Medicare and Medicaid Services
• Quality incentive program
• end-stage renal disease
• prospective payment system

• Humans
• Kidney Failure, Chronic/therapy
• Quality Improvement
• Quality Indicators, Health Care
• Reimbursement, Incentive
• Renal Dialysis
• United States

• hemodialysis
• hospital readmissions
• mortality

Peritonitis has been independently associated with increased morbidity and mortality in peritoneal dialysis patients. However, there are few reports on peritonitis in hemodialysis patients. We aim at investigating both the risk profiles and prognostic impact of peritonitis in hemodialysis patients.

This nation-wide longitudinal study uses claims data obtained from the Taiwan National Health Insurance Research Database. A total of 80,733 incident hemodialysis patients of age ≥ 20 years without a history of peritonitis were identified between January 1, 1998 and December 31, 2009. Predictors of peritonitis events were estimated using Cox proportional hazard models. Time-dependent Cox proportional hazard models were used to estimate hazard ratio for mortality attributed to peritonitis exposure.

Of 80,733 incident hemodialysis patients over a 13-year study period, peritonitis was diagnosed in 935 (1.16%), yielding an incidence rate of 2.91 per 1000 person-years. Female gender, liver cirrhosis and polycystic kidney disease were three of the most significant factors for peritonitis in both non-diabetic and diabetic hemodialysis patients. The cumulative survival rate of patients with peritonitis was 38.8% at 1 year and 10.1% at 5 years. A time-dependent Cox multivariate analysis showed that peritonitis had significantly increased hazard ratio for all cause mortality. Additionally, the risk of mortality remained significantly higher for non-diabetic hemodialysis patients that experienced peritonitis.

The risk of peritonitis in hemodialysis patients is higher in female gender, liver cirrhosis and polycystic kidney disease. Although peritonitis is a rare condition, it is associated with significantly poorer outcome in hemodialysis patients.

• Aged
• Female
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Peritonitis/mortality
• Peritonitis/physiopathology
• Renal Dialysis
• Risk Factors
• Taiwan

• Chang Gung Memorial Hospital, Linkou

• C-reactive protein
• Infective spondylodiscitis
• backache
• hemodialysis
• sepsis

• Bacteremia
• Blood stream infection
• Epidemiology
• Hemodialysis
• Infection control

• end-stage renal disease
• epidemiology and outcomes
• hemodialysis
• hospitalization
• humans
• kidney failure, chronic
• renal dialysis
• risk factors
• serum albumin
• social class

• Adolescent
• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Ambulatory Care Facilities
• Comorbidity
• Cross Infection/diagnosis
• Cross Infection/epidemiology
• Cross Infection/therapy
• Female
• Hospitalization
• Humans
• Kidney Failure, Chronic/diagnosis
• Kidney Failure, Chronic/epidemiology
• Kidney Failure, Chronic/therapy
• Male
• Medicare
• Middle Aged
• Renal Dialysis/adverse effects
• Residence Characteristics
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Rural Health Services
• Socioeconomic Factors
• United States/epidemiology
• Urban Health Services
• Young Adult

• UL1TR000002 NCATS NIH HHS
• K23 DK093584 NIDDK NIH HHS
• UL1TR000153 NCATS NIH HHS
• R01 DK092232 NIDDK NIH HHS
• UL1 TR000153 NCATS NIH HHS
• K24 DK085153 NIDDK NIH HHS
• UL1 TR000002 NCATS NIH HHS
• K24 DK085446 NIDDK NIH HHS

• Biomarkers/blood
• Cardiovascular Diseases/blood
• Cardiovascular Diseases/enzymology
• Cardiovascular Diseases/etiology
• Cardiovascular Diseases/mortality
• Female
• Follow-Up Studies
• Hospitalization/statistics & numerical data
• Humans
• Infections/blood
• Infections/enzymology
• Infections/etiology
• Infections/mortality
• Kidney Failure, Chronic/blood
• Kidney Failure, Chronic/enzymology
• Kidney Failure, Chronic/mortality
• Kidney Failure, Chronic/therapy
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Renal Dialysis/adverse effects
• Risk Factors
• Survival Rate
• gamma-Glutamyltransferase/blood