Key result
Stroke is linked to ~75-fold higher in-hospital mortality in haemodialysis patients with infective endocarditis.
Why the study?
Individuals with CKD on haemodialysis face a higher risk of infective endocarditis and worse outcomes, yet few national studies in Brazil address the epidemiology and prognosis of infective endocarditis in this population.
Cohort (n=117)
No
In a Brazilian cohort of haemodialysis patients with infective endocarditis, in-hospital mortality was high at 37.6%, with Staphylococcus aureus as the primary pathogen and stroke as a major independent predictor of mortality.
Background Individuals with chronic kidney disease (CKD) on haemodialysis (HD) have a higher risk of infective endocarditis (IE) and worse outcomes. Currently, approximately 140,000 Brazilians undergo haemodialysis (HD), yet few national studies address the epidemiology and prognosis of infective endocarditis in this population (1,2). Purpose This study aimed to analyze the epidemiology, clinical characteristics, and mortality risk factors of CKD patients on haemodialysis with IE at a Brazilian tertiary hospital. Methods Retrospective cohort study, conducted at our hospital with data collected from January 2009 to December 2024. CKD patients on HD, over 18 years old, hospitalized with IE according to the modified Duke criteria and complete data in medical records, were included. Participants were categorized into two groups based on outcomes, survival or death, for comparative analysis. Results A total of 117 patients were included. The in-hospital mortality was 37.6%. Most (88%) received dialysis with a central venous catheter; 47.9% had recent hospitalizations. Staphylococcus aureus was the main causative agent, followed by coagulase-negative staphylococci (CoNS). The mitral valve was the most affected, especially in the death outcome (p<0.001). Patients who died had higher mean age and experienced more complications during hospitalization, such as surgical treatment, intensive care unit admission, stroke, and septic shock (p<0.001). Stroke was identified as an independent risk factor for in-hospital mortality (Odds Ratio [OR] 75.156; p = 0.05). Conclusions In-hospital mortality was high, reaching 37.6%. Staphylococcus aureus was the main causative agent. Patients with death outcome were older and had more complications during hospital stay. Stroke was an independent risk factor for in-hospital mortality. A high prevalence of central venous catheters use for haemodialysis was observed, which may have contributed to increased vulnerability to infectious complications, such as infective endocarditis.
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Becker et al. (2026) conducted a cohort in Infective endocarditis in chronic kidney disease patients on haemodialysis (n=117). Stroke during infective endocarditis hospitalization in haemodialysis patients vs. Survival vs death outcome groups / absence of stroke was evaluated on In-hospital mortality (OR 75.156, p=0.05). Haemodialysis patients with infective endocarditis had a 37.6% in-hospital mortality rate, with stroke identified as an independent risk factor for death (OR 75.156; p=0.05).
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