# Clinical characteristics of Pneumocystis jirovecii pneumonia in hemodialysis patients

## TL;DR

This study compares the clinical features and outcomes of Pneumocystis jirovecii pneumonia in hemodialysis patients and non-hemodialysis patients.

## Contribution

The study provides insights into the clinical presentation and management of PJP in hemodialysis patients, highlighting diagnostic delays.

## Key findings

- HD and non-HD PJP patients showed similar symptoms and radiological findings.
- HD PJP patients had a marginally delayed time to treatment and longer treatment duration.
- No significant differences were found in mortality or PJP-related death rates between the groups.

## Abstract

Limited research exists on Pneumocystis jirovecii pneumonia (PJP) in hemodialysis (HD) patients. This retrospective study aimed to compare clinical features and outcomes of PJP in HD and non-HD patients.

We retrospectively analyzed 10 HD PJP cases and 40 non-HD PJP cases which were matched propensity scoring. Criteria included respiratory symptoms, new pulmonary infiltrates, and positive Pneumocystis real-time PCR. HD PJP patients were excluded if they were taking immunosuppressants, receiving solid organ transplant, treatment for hematological or solid cancer, HIV infection, or Pneumocystis jirovecii colonization, which was not an actual infection.

No significant differences in symptoms and radiological findings were observed between HD and non-HD PJP cases. Fever was the main symptom in both groups, ground glass opacity was the main finding on CT, and there was no significant difference between the two groups in blood test results. Although the partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio and SpO2/FiO2 ratio exhibited lower averages in the HD group, there was no significant difference between the two groups (p = 0.562 and 0.693, respectively). HD PJP patients exhibited delayed time to treatment marginally (5.3 ± 2.3 days vs. 3.0 ± 3.8 days, p = 0.051) and duration of treatment was longer than non-HD PJP (18.3 ± 3.2 days vs. 13.5 ± 7.5 days, p = 0.015). The length of stay, in-hospital mortality, and PJP-related death rate did not differ between HD PJP and non-HD PJP (p = 0.382, 0.724, and 1.000, respectively).

Our study highlights that HD patients with PJP may encounter delays in diagnosis and treatment compared to non-HD PJP patients.