Pneumocystis jirovecii pneumonia in patients with end-stage renal disease: a comparison with the general population

Abstract

Background: Data on occurrence and risk factors for pneumocystis pneumonia (PCP) in patients with end-stage renal disease (ESRD) are sparse. Methods: This was a nationwide population-based study assessing occurrence and risk factors for PCP among patients with ESRD and population controls over a 21-year period (1/1 1990 to 31/12 2010). Using Danish registry data, first-time diagnoses of PCP were identified. Results: We identified 13 296 adult patients with ESRD and 244 255 controls, yielding 63 560 and 2 223 660 person-years of follow-up (PYFU), respectively. Fifty-eight first-time diagnoses of PCP were recorded in the ESRD group. Forty-six episodes occurred among renal transplant recipients (RTx) and 12 among haemodialysis patients (HD), yielding incidence rates of 181 (136–242) and 43.1 (24.5–75.9) per 100 000 PYFU. Compared to population controls, we found incidence rate-ratios of 125.9 (78.4–204) among RTx and 29.9 (14.1–59.7) among HD patients. Risk factors for PCP in RTx were age 50–65 years, age > 65 years, diabetes, polycystic kidney disease and hypertensive kidney disease/nephrosclerosis with an IRR of 2.22 (1.14–4.31), 3.12 (1.35–7.21), 3.44 (1.16–10.2), 4.25 (1.55–11.7) and 3.87 (1.49–10.0), respectively, and more than 36 months of dialysis before transplantation with an IRR of 1.99 (1.03–3.84). Among RTx the risk of PCP was highest during the first 6 months post-transplantation and increased from the beginning (IR_1990–94 = 111 (46.3–267) per 100 000 PYFU) towards the end of the study period (IR_2005–10 = 299 (203–439)). Conclusion: The PCP risk is substantial in RTx within the first 6 months of transplantation, emphasizing the potential benefit of prophylactic treatment in the early post-transplant period. Importantly, we identified subgroups within the RTx group that require more attention.

Keywords::

• End-stage renal disease
• renal transplant recipients
• pneumocystis pneumonia
• risk factors

Acknowledgments

We would like to thank James Heaf for providing the data from the Danish Nephrology Registry and we would like to thank the Danish Nephrology Society.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.