The association of hidradenitis suppurativa with increased risk of systemic infections in end-stage renal disease.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition associated with disrupted skin integrity, while end-stage renal disease (ESRD) is marked by immune dysfunction and a heightened risk for systemic infections. The intersection of these conditions may increase susceptibility to bloodstream infections, yet this relationship remains underexplored. This study aimed to assess whether HS increases the risk of bacteremia, septicemia, and candidemia in patients with ESRD. A retrospective cohort study was conducted using the United States Renal Data System (USRDS). Adults aged 18-100 who initiated hemodialysis between 2005 and 2019 were included. A diagnosis of HS was determined via International Classification of Diseases (ICD)-9 and ICD-10 codes. Infectious outcomes, also assessed using ICD codes, were measured following HS diagnosis. Multivariable logistic regression models were used to estimate the relative risk (RR) of infection. Among 1,397,827 ESRD patients, 0.1% had HS, a prevalence that aligns with previously reported rates in the general U.S. population, suggesting that most HS cases were likely captured. After adjustment, HS was not significantly associated with diagnoses of bacteremia (RR = 0.98, 95% CI: 0.87-1.09) or candidemia (RR = 1.25, 95% CI: 0.86-1.83). However, HS was independently associated with a significantly increased risk of an ICD diagnosis of septicemia (RR = 3.24, 95% CI: 2.41-4.34). Although the prevalence of a bacteremia or candidemia diagnosis was not increased in ESRD patients with HS, these patients were more likely to be labeled as having "septicemia" per ICD codes. This highlights the importance of heightened clinical awareness and the potential need for tailored infection-prevention strategies in this subpopulation.