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CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study
Junichi Ishigami1, Morgan E Grams2, Alexander R Chang3
1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Insights
Chronic kidney disease (CKD) significantly increases infection risk, even in earlier stages. Lower estimated glomerular filtration rate (eGFR) and higher urinary albumin-creatinine ratio (ACR) are linked to higher rates of infection hospitalization and death.
Area of Science:
- Nephrology
- Infectious Diseases
- Epidemiology
Background:
- Individuals undergoing dialysis face a high risk of infection.
- However, infection risks in earlier stages of chronic kidney disease (CKD) are not well-defined.
Purpose of the Study:
- To investigate the association between chronic kidney disease (CKD) and the risk of infection hospitalization and related mortality.
- To examine the role of estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) as predictors of infection risk.
Main Methods:
- An observational cohort study involving 9,697 participants aged 53-75 from the Atherosclerosis Risk in Communities (ARIC) Study.
- Participants were followed from 1996-1998 through 2011, with data on eGFR and ACR analyzed.
- Outcomes included hospitalization with infection and infection-related death.
Main Results:
- Higher risks for infection hospitalization and death were observed with declining eGFR and increasing ACR.
- For example, compared to eGFR ≥90, HRs for hospitalization were 2.55 (eGFR 15-29) and 1.48 (eGFR 30-59).
- Compared to ACR <10, HRs for hospitalization were 2.30 (ACR ≥300) and 1.56 (ACR 30-299).
Conclusions:
- Chronic kidney disease (CKD) is an independent risk factor for infection hospitalization and mortality.
- Increased provider awareness of CKD as an infection risk is crucial for reducing morbidity and mortality.
- Findings were consistent across various infection types and recurrent episodes.
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.
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