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Mineral, bone metabolism play role in infection etiology
Mineral and bone disorder biomarkers were linked with estimated glomerular filtration rate and risk for infection, according to findings recently published in The Journal of Clinical Endocrinology and Metabolism.
Researchers wrote that the findings suggest mineral and bone disorders are involved in the etiology of infection.
“Mineral and bone disorders are common complications of chronic kidney disease, and we have recently shown an increased risk of infection in [chronic kidney disease], even at mild to moderate stages,” Junichi Ishigami, MD, MPH, of the department of epidemiology at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “Previous epidemiological studies reported an increased risk of infection associated with some [mineral and bone disorder] biomarkers; however, their generalizability may be limited due to cross-sectional design, small sample size and selected high-risk populations.”
The researchers performed a community-based cohort study of 11,218 adults from the Atherosclerosis Risk in Communities (ARIC) study, which enrolled patients aged 45 to 64 years between 1987 and 1989. All patients had eGFR at least 30 mL/min/1.73m2. Ishigami and colleagues evaluated cross-sectional associations of 25-hydroxyvitamin D, fibroblast growth factor 23 (FGF-23), parathyroid hormone, phosphorous and calcium corrected for hypoalbuminemia with eGFR between 1990 and 1992. They also examined these biomarkers’ longitudinal association with hospitalization for infection from 1990 to 2013. The main outcome was incident hospitalization with infection.
Lower eGFR was associated with higher levels of parathyroid hormone, FGF-23 and corrected calcium, the researchers reported. However, eGFR was not linked with phosphorous or 25-(OH)D.
Ishigami and colleagues reported a total of 5,078 hospitalizations with infection during follow-up. The HR for hospitalization was significantly higher for the highest quartile of FGF-23 (HR = 1.12; 95% CI, 1.03-1.21), parathyroid hormone (HR = 1.09; 95% CI, 1.01-1.18) and corrected calcium (HR = 1.11; 95% CI, 1.03-1.2), as well as the lowest quartile of 25-(OH)D (HR = 1.11; 95% CI, 1.03-1.21), the researchers wrote.
Phosphorous was significantly associated with hospitalization only when researchers restricted the outcome to patients with a primary diagnosis of infection. These associations held true across subgroups of age, sex, race and eGFR (< 60 mL/min/1.73m2 vs. 60 mL/min/1.73m2), Ishigami and colleagues reported.
“In longitudinal analysis, elevated levels of FGF-23, [parathyroid hormone] and corrected calcium and lower 25-(OH)D were each associated with an increased risk for hospitalization with infection,” the researchers wrote. “These findings support the involvement of mineral and bone metabolism in the etiology of infection.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.