Burden and Risk Factors for Staphylococcus aureus-Related Sepsis among US Dialysis Patients: A Retrospective Claims-Based Cohort Study.

BACKGROUND

Patients receiving dialysis, particularly those on hemodialysis with central venous catheters (CVC), are at higher risk of bloodstream infections, often caused by Staphylococcus aureus. After years of declining CVC prevalence, pandemic-related shifts in dialysis practices led to higher CVC use and increased concern regarding contemporary infection risk. This study used national data spanning pre-, intra-, and post-pandemic periods to determine current rates and risk factors for S. aureus-related sepsis in the US dialysis population.

METHODS

A retrospective cohort study was conducted using Centers for Medicare & Medicaid Services claims and United States Renal Data System data from 2016 through 2023 for adults >18 years of age receiving maintenance dialysis. S. aureus-related sepsis was identified using ICD-10 codes A41.01 and A41.02. Event rates per 100 patient-years (PY) were calculated for first and multiple events, stratified by demographic and clinical characteristics. Cox regression was used to identify risk factors.

RESULTS

CVC use rose from 16% in 2016 to 24% in 2023. S. aureus-related sepsis incidence was 3.3 per 100 PY for first events and 4.1 per 100 PY for multiple events. First-event rates were higher among HD recipients using CVCs (8.4) versus those with arteriovenous fistulas (2.0) or peritoneal dialysis recipients (1.0). Rates were elevated in younger patients, males, and those with diabetes, heart failure, or immunosuppressive conditions. In adjusted models, catheter use (vs. fistulas) was strongly associated with S. aureus-related sepsis (hazard ratio: 4.24, 95% confidence interval: 4.15 to 4.33).

CONCLUSIONS

S. aureus-related sepsis remains a substantial burden among US dialysis patients, especially among CVC users, presenting a persistent challenge for the nephrology community in the context of rising CVC prevalence post-pandemic. Despite modest overall declines since 2016, persistent high rates underscore the need for targeted prevention, particularly optimizing vascular access and managing high-risk subgroups.