Abstract
Non-tuberculous mycobacterial (NTM) disease has increased in prevalence in the USA, however, little is known on NTM in the population with end-stage renal disease (ESRD). Thus, we investigated patients with ESRD to determine risk factors for NTM disease and mortality. We queried the United States Renal Data System from 2005 to 2015 using International Classification of Diseases (ICD)-9/ICD-10 codes to identify NTM and risk factors. Logistic regression was used to examine the association of risk factors with NTM and Cox proportional hazards modeling was used to assess the association of NTM with mortality. Of 1,068,634 included subjects, 3232 (0.3%) individuals were identified with any NTM diagnosis. Hemodialysis versus peritoneal dialysis (OR=0.10, 95% CI=0.08 to 0.13) was protective for NTM, whereas black (OR=1.27, 95% CI=1.18 to 1.37) or other race compared with white race (OR=1.39, 95% CI=1.21 to 1.59) increased the risk of NTM. HIV (OR=15.71, 95% CI=14.24 to 17.33), history of any transplant (OR=4.25, 95% CI=3.93 to 4.60), kidney transplant (OR=3.00, 95% CI=2.75 to 3.27), diabetes (OR=1.32, 95% CI=1.23 to 1.43), rheumatologic disease (OR=1.92, 95% CI=1.77 to 2.08), and liver disease (OR=2.09, 95% CI=1.91 to 2.30) were associated with increased risk for NTM diagnosis. In multivariable analysis, there was a significant increase in mortality with any NTM diagnosis (HR=1.83, 95% CI=1.76 to 1.91, p≤0.0001). Controlling for relevant demographic and clinical risk factors, there was an increased risk of mortality associated with any diagnosis of NTM. Early diagnosis and treatment of NTM infection may improve survival in patients with ESRD.
Footnotes
Twitter @StephanieBaerMD
Contributors ET, JLW, WBB, BS, AM, MK, SP, LY, SLB, and ST conceptualized the project. JLW created the analysis dataset and curated and created the models to analyze the data. ET, JLW, and ST obtained and interpreted the data. ET, JLW, and ST wrote the original draft. ET, JLW, WBB, BS, AM, MK, SP, LY, SLB, and ST reviewed and edited the manuscript. ET, JLW, and ST visualized the data. JLW, SLB, and ST supervised the project. JLW, SLB, and ST administered the project and AM and MK acquired funding to support the study. All authors contributed to critical revision and have approved the manuscript, contributed significantly to the work, and approved its submission to the Journal of Investigative Medicine. All authors agree to be accountable for all aspects of the work ensuring questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SLB is the guarantor.
Funding This work was supported in part by the Translational Research Program of the Medical College of Georgia Department of Medicine. Support for research time was provided by the Charlie Norwood VA Medical Center (SLB). The data reported here have been supplied by the United States Renal Data System.
Competing interests SLB is an Editorial Board member for the Journal of Investigative Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Data availability statement
Data are available on reasonable request. The data underlying this article are available in the United States Renal Data System (USRDS) database, at https://www.usrds.org/for-researchers/simple-data-requests/ and can be accessed by submitting a Simple Data Request form.
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