Hospitalizations for fungal infections after initiation of chronic dialysis in the United States

Kevin C. Abbott*, Iman Hypolite, Daniel P. Tveit, Paul Hshieh, David Cruess, Lawrence Y. Agodoa

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


Aims: Hospitalized fungal infections are reported frequently in renal transplant recipients and peritoneal dialysis patients, but the frequency of hospitalized fungal infections in dialysis patients has not been studied in a national population. Methods: 327,993 dialysis patients in the United States Renal Data System initiated from January 1, 1992 to June 30, 1997 were analyzed in a retrospective registry study of fungal infections (based on ICD9 Coding). Results: Dialysis patients had an age-adjusted incidence ratio for fungal infections of 9.80 (95% confidence interval (CI) 6.34-15.25)) compared to the general population in 1996 (the National Hospital Discharge Survey). Candidiasis accounted for 79% of all fungal infections, followed by cryptococcosis (6.0%) and coccidioidomycosis (4.1%). In multivariate analysis, fungal infections were associated with earlier year of dialysis, diabetes, female gender, decreased weight and serum creatinine at initiation of dialysis, chronic obstructive lung disease and AIDS. In Cox regression analysis the hazard ratio for mortality of fungal infections was 1.35 (95% CI 1.28-1.42). Conclusions: Dialysis patients were at increased risk for fungal infections compared to the general population, which substantially decreased patient survival. Female and diabetic patients were at increased risk for fungal infections. Although candidiasis was the dominant etiology of fungal infections, the frequency of cryptococcosis and coccidioidomycosis were higher than previously reported.

Original languageEnglish
Pages (from-to)426-432
Number of pages7
Issue number4
StatePublished - 2001
Externally publishedYes


  • Aspergillus
  • Candida
  • Coccidioidomycosis
  • Cryptococcosis
  • Diabetes mellitus
  • Dialysis
  • Fungal infection
  • Meningitis
  • Mycoses
  • Zygomyces


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