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

Abstract

Background Individuals on dialysis have a high risk of infection, but risk of infection in earlier stages of chronic kidney disease (CKD) has not been comprehensively described. Study Design Observational cohort study. Setting & Participants 9,697 participants (aged 53–75 years) in the Atherosclerosis Risk in Communities (ARIC) Study. The participants were followed up from 1996–1998 through 2011. Predictors Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) Outcomes Risk of hospitalization with infection, and death during or within 30-days of hospitalization with infection. Results During follow-up (median, 13.6 years), there were 2,701 incident hospitalizations with infection (incidence rate, 23.6 per 1,000 person-years) and 523 infection-related deaths. In multivariable analysis, the HRs of incident hospitalization with infection as compared to eGFR ≥90 ml/min/1.73 m2 were 2.55 (95% CI, 1.43–4.55), 1.48 (95% CI, 1.28–1.71), and 1.07 (95% CI, 0.98–1.16) for eGFR 15–29, 30–59, and 60–89 ml/min/1.73 m2, respectively. Corresponding HRs were 3.76 (95% CI, 1.48–9.58), 1.62 (95% CI, 1.20–2.19), and 0.99 (95% CI, 0.80–1.21) for infection-related death. Compared to ACR <10 mg/g, the HRs of incident hospitalization with infection were 2.30 (95% CI, 1.81–2.91), 1.56 (95% CI, 1.36–1.78), and 1.34 (95% CI, 1.20–1.50) for ACR ≥300, 30–299, and 10–29 mg/g, respectively. Corresponding HRs were 3.44 (95% CI, 2.28–5.19), 1.57 (95% CI, 1.18–2.09), and 1.39 (95% CI, 1.09–1.78) for infection-related death. Results were consistent when separately assessing risk for pneumonia, kidney and urinary tract infections, blood stream infections, and cellulitis, and when taking into account recurrent episodes of infection. Limitations Outcome ascertainment relied on diagnostic codes at time of discharge. Conclusions Increasing provider awareness of CKD as a risk factor for infection is needed to reduce infection-related morbidity and mortality.

Suboptimal initiation predicts short‐term prognosis and vulnerability among very elderly patients who start haemodialysis

“…The most common cause of death related to suboptimal initiation was found to be infection in the present study; and pneumonia was the leading cause of infectious death among the patients who commenced haemodialysis in a suboptimal manner. In previous studies, the higher mortality and morbidity rates from pneumonia were stated to be well known among incident dialysis patients, and CKD patients from an early stage . In the present study, the patients who died from pneumonia had experienced a longer length of stay and a higher frequency of previous hospitalizations compared to the patients who did not.…”

“…In previous studies, the higher mortality and morbidity rates from pneumonia were stated to be well known among incident dialysis patients, 22 and CKD patients from an early stage. 23 In the present study, the patients who died from pneumonia had experienced a longer length of stay and a higher frequency of previous hospitalizations compared to the patients who did not. Additionally, ADL among patients complicated with pneumonia had remarkably declined, and half of them were already bed-ridden on admission.…”

Clinical epidemiology of infectious disease among patients with chronic kidney disease

“…Previous studies also reported an increased risk of infection-related death associated with reduced eGFR (Table 1) [8, 15, 16]. However, we should interpret those results carefully since definitions of infection-related death varied across studies.…”

Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Organisms: a Multicenter Cohort Study

“…Although age-related immunosenescence may be associated with infection-related mortality, it is also associated with diseases such as diabetes mellitus and chronic kidney disease (22,23). Moreover, there may be a difference between biological age and chronological age.…”