ESRD: seasonal influenza-like illness tied to excess deaths

  • Gilbertson DT & al.
  • J Am Soc Nephrol
  • 24 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Influenza-like illness (ILI) likely contributes to ~1100 deaths annually among U.S. patients with end-stage renal disease (ESRD).
  • 14-year data point to an association between community ILI activity and seasonal variations in all-cause mortality in this population.

Why this matters

  • "Generally speaking, during influenza/ILI seasons when influenza and ILI peaked early, more deaths occurred early, and when the illness peak was later, the peak in deaths was also later. Similarly, years when influenza and ILI were particularly bad were generally years when the number of deaths was also higher than expected,” lead investigator David Gilbertson, PhD, said in a news release.
  • "While ILI may not be the direct cause of death in ESRD patients, it may contribute to other causes of death; for example, patients with ILI may experience a state of acute inflammation, making them vulnerable to other infections or cardiovascular events," Dr. Gilbertson warned.

Study design

  • Analysis of ILI surveillance data from CDC, paired with Medicare ESRD mortality data for 2000-2013.
  • ILI defined as fever >100°F (37.8°C) accompanied by cough/sore throat.
  • Funding: Amgen, Inc.

Key results

  • Annual deaths attributable to ILI ranged from 633 (2011-2012) to 1604 (2009-2010).
  • During January-March (peak ILI season), a 1% absolute increase in ILI was tied to a 2.0% (95% CI, 0.2%-3.9%) increase in mortality vs July-September.
  • During October-December (second highest ILI rate), a 1% absolute increase in ILI was tied to a 1.5% (95% CI, 0.6%-2.4%) increase in mortality vs July-September.

Limitations

  • Observational, retrospective design.
  • Other causes of mortality not captured (e.g., falls).

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