Pyogenic Liver Abscess in ESRD Patients Undergoing Maintenance Dialysis Therapy

Background: Patients with end-stage renal disease (ESRD) on dialysis therapy have increased susceptibility to bacterial infection. Data regarding pyogenic liver abscess in this population are rare. Methods: We retrospectively examined all cases of pyogenic liver abscess in patients undergoing maintenance dialysis therapy in 2 tertiary referral centers. Medical records of patients with ESRD with a pyogenic liver abscess from January 1995 to September 2004 were studied. Results: Twenty-seven of 20,676 admitted patients with ESRD were found to have a pyogenic liver abscess. The major predisposing factor was diabetes mellitus (59.3%). The most common clinical symptoms were fever and chills (85.2%). A rare presentation of hiccup was noted in 2 peritoneal dialysis patients, and endophthalmitis was noted in 2 patients with liver abscess caused by Klebsiella pneumoniae. Abscesses were located mainly in the right lobe (70.4%) and presented as a solitary mass (74.1%). K pneumoniae was the most common bacteria isolated in blood cultures (51.9%) and liver abscess aspirates (37%). Invasive drainage approaches performed in 17 patients (63%) resulted in a unique complication of peritonitis in 4 peritoneal dialysis patients. The difference in mortality rates between patients who underwent invasive procedures and those who did not was not significant (P = 0.68). The overall in-hospital mortality rate of patients with ESRD with a pyogenic liver abscess was 33.3%. Conclusion: Although pyogenic liver abscess is uncommon in patients with ESRD undergoing maintenance dialysis therapy, it is still a disease of significant mortality.