Chronic Kidney Disease and Risk of Death from Infection

Abstract

Background: Infection, bacteremia and sepsis are major sources of morbidity and mortality in patients with end-stage renal disease. This study sought to determine the association between predialysis chronic kidney disease (CKD) and infection-related mortality. Methods: We analyzed participants in the Third National Health and Nutrition Examination Survey (NHANES III). The study included adults ≧45- years-old without end-stage renal disease. Estimated glomerular filtration rate (eGFR) was categorized as ≧60, 45–59.9 and <45 ml/min per 1.73 m², and urinary albumin-to-creatinine ratio (ACR) as <30, 30–299.9 and ≧300 mg/g. The study identified infection-related mortality, including septicemia, respiratory, abdominal and gastrointestinal, cardiac, kidney and genitourinary, neurologic, and other infections over a median of 13 years using the National Death Index. Results: Of 7,400 participants included in the study, 206 died from infections. Compared to individuals with eGFR ≧60 ml/min per 1.73 m², infection-related mortality was higher for those with lower eGFR [adjusted HR = 1.36 (95% CI: 0.81, 2.30) and 2.36 (1.04, 5.38) for eGFR of 45–59.9 and <45 ml/min per 1.73 m², respectively; p trend = 0.06]. Compared to individuals with ACR <30 mg/g, infection-related mortality was higher for ACR levels of 30–299 and ≧300 mg/g [adjusted HR = 1.68 (95% CI: 0.97, 2.92) and 2.84 (0.92, 8.74), p trend = 0.02]. Conclusions: Reduced eGFR and albuminuria are associated with increased risk for infection-related mortality. Efforts are needed to reduce its incidence and mitigate the effects of infections among individuals with CKD.

CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study

“…The results in the present study were consistent with the previous findings in terms of overall relationship between reduced kidney function and infection, 8–10, 12, 13 but had several unique aspects. First, the use of the creatinine and cystatin C equation, which is considered the best estimate for GFR, allowed us to better quantify the risk of infection across clinical categories of eGFR.…”

“…11, 12 In the general population, one study simultaneously explored the infection risk of both eGFR and albuminuria, but that study investigated only mortality related to infection. 13 …”

Prognostic Impact of Subclinical Microalbuminuria in Patients With Chronic Heart Failure

“…34 Second, reduced eGFR and albuminuria are associated with increased risk for infection-related mortality. 35 Thus, it is conceivable that subclinical microalbuminuria was associated with non-cardiovascular death, at least in part, as a reflection of severer general condition in CHF patients in the present study.…”

Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness

“…diabetes), anatomical abnormalities (e.g. polycystic kidney) and repetitive exposures to nosocomial microorganisms can increase the risk of the occurrence of sepsis [40]. The most common source of infection is represented by indwelling catheters followed by lower respiratory tract infections [41], cellulitis and pyocystis [42,43] as well as the breaching of cutaneous barriers.…”