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Am J Kidney Dis. 2017 Jun;69(6):752-761. doi: 10.1053/j.ajkd.2016.09.018. Epub 2016 Nov 22.

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

Author information

1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
2
Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
3
Division of Nephrology, Geisinger Health System, Danville, PA.
4
Division of Nephrology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
5
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: kmatsush@jhsph.edu.

Abstract

BACKGROUND:

Individuals on dialysis therapy have a high risk for infection, but risk for infection in earlier stages of chronic kidney disease 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. Participants were followed up from 1996 to 1998 through 2011.

PREDICTORS:

Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR).

OUTCOMES:

Risk for 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, 23.6/1,000 person-years) and 523 infection-related deaths. In multivariable analysis, HRs of incident hospitalization with infection as compared to eGFRs≥90mL/min/1.73m2 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 eGFRs of 15 to 29, 30 to 59, and 60 to 89mL/min/1.73m2, 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 ACRs<10mg/g, 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 ACRs≥300, 30 to 299, and 10 to 29mg/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, bloodstream 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 chronic kidney disease as a risk factor for infection is needed to reduce infection-related morbidity and mortality.

KEYWORDS:

Chronic kidney disease (CKD); albuminuria; bacteremia; cellulitis; chronic kidney failure; chronic renal insufficiency; glomerular filtration rate (GFR); hospitalization; infection; infectious disease; kidney function; pneumonia; proteinuria; respiratory tract infections; urinary tract infections

PMID:
27884474
PMCID:
PMC5438909
DOI:
10.1053/j.ajkd.2016.09.018
[Indexed for MEDLINE]
Free PMC Article

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