B25-17 Candidemia in CRRT Patients: A Nationwide IPTW-weighted Analysis of Acute Mortality and Longitudinal Healthcare Burden

Rationale Candidemia is a severe bloodstream infection that disproportionately affects critically ill patients. In those receiving continuous renal replacement therapy (CRRT), fungal infections may compound already high morbidity and mortality, yet their independent contribution to clinical and economic outcomes remains poorly understood. We aimed to assess the burden of candidemia on outcomes in CRRT recipients using a nationally representative dataset. Methods We conducted a retrospective cohort study of adult hospitalizations in the 2022 Nationwide Readmissions Database (NRD) requiring CRRT. Candidemia was identified as a secondary diagnosis using ICD-10 codes. Inverse probability of treatment weighting (IPTW) was applied to balance for age, sex, mechanical ventilation, ECMO, heart failure (acute/chronic), COPD, coronary artery disease, liver disease, diabetes, obesity, tracheostomy, ARDS, and immunosuppression.The primary outcome was in-hospital mortality. Secondary outcomes included non-home discharge, tracheostomy, major morbidity (death, stroke, bleeding, tracheostomy, ECMO, ventilation, or ARDS), 30-, 90-, and 180-day readmissions, length of stay (LOS), total hospital charges, and 6-month cumulative LOS and charges (index + readmissions). Adjusted associations were estimated using multivariate logistic and linear regression. Results Among 457,531 CRRT hospitalizations, 7,816 (1.7%) developed candidemia. These patients were slightly younger (mean age 62.1 vs. 63.2 years) and more often female (67.1% vs. 44.1%, p < 0.001). After IPTW adjustment, candidemia was associated with significantly higher in-hospital mortality (27.3% vs. 8.1%; aOR 1.44, p < 0.001). Mean LOS was longer (28.9 vs. 10.0 days, p < 0.001), and mean total charges were substantially higher ($476,700 vs. $151,700; +227%, p < 0.001).At 6 months, cumulative LOS remained elevated (30.5 vs. 19.2 days, p < 0.001), as did cumulative charges ($472,000 vs. $272,000; +74%, p < 0.001). Thirty-, 90-, and 180-day readmissions were paradoxically lower among candidemia patients (-4.8%, -6.2%, -9.1%; all p < 0.001), reflecting excess early mortality. Non-home discharge ( +8.5%, p < 0.001) and tracheostomy ( +2.4%, p < 0.001) were more frequent. Major morbidity occurred in 17.8% of candidemia vs. 8.2% of non-candidemia cases (p < 0.001). Conclusions our study dhowed that candidemia in CRRT patients identifies a highly vulnerable population with over threefold higher mortality, more than double the resource use, and substantially prolonged hospital stays. Despite lower readmission rates—likely due to early deaths—the 6-month cumulative burden remains profound. These findings underscore candidemia as a marker of extreme physiologic frailty in renal replacement therapy and highlight the need for aggressive antifungal stewardship, early detection, and preventive infection-control strategies in the ICU This abstract is funded by: None