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Poor kidney function increases risk for community-acquired infections
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Patients with reduced kidney function had an increased risk for developing community-acquired infections — including respiratory, urinary tract and skin infections — according to a recent study published in the Clinical Journal of the American Society of Nephrology.
“Chronic kidney disease (CKD) is common, with a population prevalence of 5% to 15% in most developed countries, and is associated with a markedly increased risk of death and hospitalizations,” Hong Xu, MD, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Stockholm, Sweden, and colleagues wrote. “Infections are probably the most significant and serious noncardiovascular complications among persons with CKD. Decreased kidney function leads to retention of metabolic waste products and alteration of multiple pathways, including the immune system.”
Although previous studies have linked mildly or moderately reduced kidney function to an increase in infections, the researchers noted that a more comprehensive analysis involving the full spectrum of kidney function was lacking. To further investigate the association, Xu and colleagues examined data on 1,139,470 participants enrolled in the SCREAM project, which collected serum creatinine measurements from residents seeking ambulatory or hospital care in Stockholm from 2006 to 2011. They hypothesized that participants with a lower estimated glomerular filtration rate (eGFR) were more likely to develop community-acquired infections (CAIs) than patients with a higher eGFR. They followed participants for 12 months. Those diagnosed with an infection 3 months before sample collection were excluded from the analysis.
More than 106,800 infections were identified over 1,128,313 person-years. The most common infections included skin and soft tissue infections (28 per 1,000 person-years), UTIs (21 per 1,000 person-years), lower respiratory tract infections (15 per 1,000 person-years), upper respiratory tract infections (11 per 1,000 person-years) and gastrointestinal infections (10 per 1,000 person-years).
The incidence rate of infection increased with lower eGFR, from 74 per 1,000 person-years among individuals with normal kidney function (eGFR of 90 to 104 ml/min/1.73m²) to 419 per 1,000 person-years with stage four or higher CKD (eGFR < 30 ml/min/1.73m²). Compared with those with normal kidney function, the adjusted incidence rate of CAI was 1.08 (95% CI, 1.01-1.14) among participants with stage 3 CKD (eGFR of 30-59 ml/min/1.73m²) and 1.53 (95% CI, 1.39-1.69) among those with stage 4 or higher CKD.
“This increased risk was observed for most infection types, with the exception of upper respiratory tract and central nervous system infections, which did not clearly associate with eGFR,” Xu and colleagues noted. “These are novel observations for which there is no comparison in the literature and warrant further confirmation.”
Meanwhile, the relative proportion of certain CAIs increased with lower eGFR strata. For example, the proportion of UTIs and lower respiratory tract infections were 38% and 25%, respectively, among patients with severe loss of CKD vs. 16% and 15% among those with normal kidney function. A similar pattern was observed for sepsis, according to the researchers.
“Given the fact that CKD remains underdiagnosed and unrecognized in most societies, including ours, our findings may help clinicians become more aware of CKD and its complications,” they concluded. “This, in turn, may be useful to identify patients at increased risk of infection and inform discussions about infection risk and vaccination strategies.” – by Stephanie Viguers
Disclosure: One author is an employee of Baxter Healthcare Corporation.
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