Acute kidney injury (AKI) requiring dialysis remains a serious complication of infective endocarditis (IE), although data describing associated risk factors and outcomes remain limited. A nationwide Danish registry study published in the American Heart Journal evaluated predictors of dialysis-requiring AKI and its association with short- and longer-term mortality in patients hospitalized with first-time left-sided IE.

Using the NIDUS registry, the analysis included dialysis-naive patients hospitalized with left-sided IE between 2016 and 2021. Patients were categorized according to whether dialysis was initiated during hospitalization for AKI. Risk factors for dialysis initiation were assessed using multivariable logistic regression, while mortality outcomes were evaluated using Kaplan–Meier analyses and Cox proportional hazards models.

Findings

• Dialysis-requiring AKI developed in 203 of 2,738 patients (7%) hospitalized with left-sided infective endocarditis.
• Valvular surgery was more frequent among patients requiring dialysis versus those who did not require dialysis (57.0% vs 19.8%; P < 0.01), with nearly two-thirds initiating dialysis postoperatively.
• Independent factors associated with dialysis initiation included chronic kidney disease, diabetes, liver disease, sepsis, valvular surgery, and Staphylococcus aureus or Enterococcus infection.
• In-hospital mortality was higher among patients requiring dialysis (37.9% vs 16.5%; HR 1.86; 95% CI, 1.39-2.50).
• Among hospital survivors, mortality within 3 months after discharge remained higher in patients requiring dialysis (12.0% vs 9.0%; HR 2.35; 95% CI, 1.30-4.27), while mortality between 3 and 12 months was similar between groups.

In this nationwide cohort of patients with left-sided IE, dialysis-requiring AKI was associated with increased early mortality and a greater burden of comorbid disease.