Pneumococcal pneumonia infection is associated with end-stage renal disease in adult hospitalized patients

Abstract

Pneumococcal disease leads to renal complications ranging from persistent proteinuria to end-stage renal disease (ESRD) in pediatric patients. However, long-term renal effects after pneumococcal pneumonia infection in adult patients remains largely unknown. To evaluate this we conducted a population-based retrospective cohort study consisting of 18,733 adult patients at the time of pneumococcal pneumonia diagnosis, using claims data from Taiwan's National Health Insurance Research Database (NHIRD) with a comparison cohort of 73,409 age- and gender-matched patients without pneumococcal pneumonia. The overall incidence rate ratio of ESRD was 23% higher in those with pneumococcal pneumonia than in those without pneumococcal pneumonia (5.26 vs. 3.10 per 1000 person-years), with an adjusted hazard ratio of 1.14 (95% confidence interval 1.01-1.29). In addition, the risk of developing ESRD was associated with covariates including age, gender, chronic kidney disease, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, and heart failure. The ESRD cumulative incidence curve showed a considerably higher risk of ESRD in those with pneumococcal pneumonia than in those without pneumococcal pneumonia (significant by log-rank test). Thus, pneumococcal pneumonia may be associated with an increased risk of ESRD in adult patients. A long-term follow-up of renal function is recommended for adult hospitalized patients with pneumococcal pneumonia infection.

Association of Kidney Function with Infections by Multidrug-Resistant Organisms: An Electronic Medical Record Analysis

“…Frequent exposure to antibiotics is the main driver of ABR 1 . Patients with reduced eGFR have a higher risk of antimicrobial exposure due to their susceptibility to infections 6 , 8 , 9 , 18 – 20 , either prescribed by physicians or self-prescribed. Infection susceptibility due to immune dysfunction has also been proposed in patients with impaired renal function, including increased production of reactive oxygen species (ROS), accumulation of toxic products, and functional abnormalities of monocytes, T lymphocytes and natural killer cells 21 , 22 .…”

Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease

“…Epidemiological studies have reported an association between pneumonia and subsequent acute kidney injury and end-stage renal disease, supporting our findings that infections may trigger not only acute but also chronic renal damage. 37,38…”

Mortalidade e custos da pneumonia pneumocócica em adultos: um estudo transversal

“…Several studies have suggested a relationship between chronic renal disease and PP, although the pathophysiological mechanisms involved are not well understood. (25) Several existing studies have suggested that a high risk of pneumococcal disease is associated with primary immunodeficiency due to B cell defects. (26) Solid tumors and hematological malignancies also predispose individuals to infections, especially by gram-positive bacteria.…”