**4.6. Intravenous drug users**

**4.3. Rheumatic heart disease (RHD)**

126 Contemporary Challenges in Endocarditis

patients with IE that 33% had RHD.

**4.4. Chronic degenerative diseases (CDD)**

respectively.

RHD in IE [20].

*• Systemic hypertension*

*• Coronary artery disease (CAD)*

*• Congestive heart failure (CHF)*

term [8, 15, 16].

long term in these patients [8, 15, 16].

*• Diabetes*

The RHD, which was the leading cause of IE in the preantibiotics era, is now rare in developed countries. However, it remains a highly prevalent disease in developing countries. More developed areas, such as Hong Kong and Thailand, still have a case of IE in 18 and 12%,

Chou et al. in their study compared 68,426 adult patients with ESRD in HD with two groups: with IE and without IE. They found that 1.2% without IE and 4.4% with IE, respectively, had the RHD, having a statistical significance *p* < 0.001, relative to RHD and IE in HD patients [16]. The same study shows the differences in incidence among Asian countries and the western countries. However, many western countries, such as in the case of Mexico and parts of South America, are still considered to be endemic for this disease. Simsek-Yavuz et al. in their study in Turkey also noted the difference in incidence among the developed countries and found low incidence of RHD compared with developing countries. They presented their work in 325

Although this study is not specifically for HD patients, it demonstrates a high prevalence of

There is a close relationship between HD patients and diabetes, with the incidence of IE.

cance compared with HD patients with DM without IE, *p* < 0.001 [15, 16].

There are studies that have an incidence of 33–59.4% of patients having statistical signifi-

This condition is related to ESRD patients with HD and IE having an incidence of up 89.9% [15].

Kamalakannan et al. in their study with 69 patients showed an incidence of 24.6% of CAD in HD patients with IE. Chou et al. found *p* < 0.001 between HD patients with IE versus the HD patient without IE. This disease is considered to be a potential cause of death in the short and

Kamalakannan et al. in their study with 69 patients showed an incidence of 18.8% of CHF in this group of patients. Chou et al. compared CHF in HD patients with IE versus HD patients without IE and found significant differences *p* < 0.001, being the HD patients with IE, the group with more CHF, which also indicates the direct cause of death in these patients in the short Although it is a rare case of IE in HD patients, Kamalakannan et al. reported an incidence of 11.6% representing eight patients of the study [8]. Also in some countries such as Finland they found an increase in IV drug abuse as a risk factor for IE patients being 0% in the 1980s and mid-1990s to 20% in 2000–2004 [22].
