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Excess Deaths Attributable to Influenza-Like Illness in the ESRD Population.

  • Gilbertson, David T1, 2
  • Rothman, Kenneth J3, 4, 5
  • Chertow, Glenn M6
  • Bradbury, Brian D7
  • Brookhart, M Alan8
  • Liu, Jiannong9
  • Winkelmayer, Wolfgang C10
  • Stürmer, Til8
  • Monda, Keri L7
  • Herzog, Charles A9, 2
  • Ashfaq, Akhtar11
  • Collins, Allan J2, 12
  • Wetmore, James B9, 2, 13
  • 1 Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; [email protected]
  • 2 Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
  • 3 Research Triangle Institute Health Solutions, Research Triangle Park, North Carolina.
  • 4 Departments of Epidemiology and.
  • 5 Medicine, Boston University Medical Center, Boston, Massachusetts.
  • 6 Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
  • 7 Center for Observational Research, Amgen, Inc., Thousand Oak, California.
  • 8 Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
  • 9 Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
  • 10 Department of Medicine-Nephrology, Baylor College of Medicine, Houston, Texas.
  • 11 Renal Division, Opko Pharmaceuticals, Miami, Florida.
  • 12 NxStage Medical, Inc., Lawrence, Massachusetts; and.
  • 13 Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota.
Published Article
Journal of the American Society of Nephrology
American Society of Nephrology
Publication Date
Feb 01, 2019
DOI: 10.1681/ASN.2018060581
PMID: 30679380


Morbidity and mortality vary seasonally. Timing and severity of influenza seasons contribute to those patterns, especially among vulnerable populations such as patients with ESRD. However, the extent to which influenza-like illness (ILI), a syndrome comprising a range of potentially serious respiratory tract infections, contributes to mortality in patients with ESRD has not been quantified. We used data from the Centers for Disease Control and Prevention (CDC) Outpatient Influenza-like Illness Surveillance Network and Centers for Medicare and Medicaid Services ESRD death data from 2000 to 2013. After addressing the increasing trend in deaths due to the growing prevalent ESRD population, we calculated quarterly relative mortality compared with average third-quarter (summer) death counts. We used linear regression models to assess the relationship between ILI data and mortality, separately for quarters 4 and 1 for each influenza season, and model parameter estimates to predict seasonal mortality counts and calculate excess ILI-associated deaths. An estimated 1% absolute increase in quarterly ILI was associated with a 1.5% increase in relative mortality for quarter 4 and a 2.0% increase for quarter 1. The average number of annual deaths potentially attributable to ILI was substantial, about 1100 deaths per year. We found an association between community ILI activity and seasonal variation in all-cause mortality in patients with ESRD, with ILI likely contributing to >1000 deaths annually. Surveillance efforts, such as timely reporting to the CDC of ILI activity within dialysis units during influenza season, may help focus attention on high-risk periods for this vulnerable population. Copyright © 2019 by the American Society of Nephrology.

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