The Risk of Infection-related Hospitalization with Decreased Kidney Function

Overview

Journal Am J Kidney Dis

Specialty Nephrology

Date 2011 Sep 13

PMID 21906862

Citations 66

Authors

Lorien S Dalrymple

Ronit Katz

Bryan Kestenbaum

Ian H de Boer

Linda Fried

Mark J Sarnak

Michael G Shlipak

Affiliations

Soon will be listed here.

Abstract

Background: Moderate kidney disease may predispose to infection. We sought to determine whether decreased kidney function, estimated by serum cystatin C level, was associated with the risk of infection-related hospitalization in older individuals.

Study Design: Cohort study.

Setting & Participants: 5,142 Cardiovascular Health Study (CHS) participants with measured serum creatinine and cystatin C and without estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m(2) at enrollment.

Predictor: The primary exposure of interest was eGFR using serum cystatin C level (eGFR(SCysC)).

Outcome: Infection-related hospitalizations during a median follow-up of 11.5 years.

Results: In adjusted analyses, eGFR(SCysC) categories of 60-89, 45-59, and 15-44 mL/min/1.73 m(2) were associated with 16%, 37%, and 64% greater risk of all-cause infection-related hospitalization, respectively, compared with eGFR(SCysC) ≥90 mL/min/1.73 m(2). When cause-specific infection was examined, eGFR(SCysC) of 15-44 mL/min/1.73 m(2) was associated with an 80% greater risk of pulmonary and 160% greater risk of genitourinary infection compared with eGFR(SCysC) ≥90 mL/min/1.73 m(2).

Limitations: No measures of urinary protein, study limited to principal discharge diagnosis.

Conclusions: Lower kidney function, estimated using cystatin C level, was associated with a linear and graded risk of infection-related hospitalization. These findings highlight that even moderate degrees of decreased kidney function are associated with clinically significant higher risks of serious infection in older individuals.

Citing Articles

Distinct Neutralising and Complement-Fixing Antibody Responses Can Be Induced to the Same Antigen in Haemodialysis Patients After Immunisation with Different Vaccine Platforms.

Wall N, Lamerton R, Ashford F, Perez-Toledo M, Jasiulewicz A, Banham G Vaccines (Basel). 2025; 13(1).

PMID: 39852786 PMC: 11768972. DOI: 10.3390/vaccines13010007.

Association of estimated glomerular filtration rate with the incidence of sleep apnea syndrome.

Azegami T, Kaneko H, Okada A, Suzuki Y, Ko T, Fujiu K Sleep. 2024; 48(3).

PMID: 39704496 PMC: 11893532. DOI: 10.1093/sleep/zsae302.

Clinical implications of the newly defined concept of ventilator-associated events in trauma patients.

Lee T, Oh J, Lee M, Kim J, Sohn J, Wi J J Trauma Inj. 2024; 35(2):76-83.

PMID: 39381182 PMC: 11309180. DOI: 10.20408/jti.2021.0064.

Complications and Mortality After Surgery in Patients with Chronic Kidney Disease: A Retrospective Cohort Study Based on a Multicenter Clinical Database.

Liao C, Liu C, Lee Y, Chang C, Yeh C, Chang T J Multidiscip Healthc. 2024; 17:3535-3544.

PMID: 39070691 PMC: 11283266. DOI: 10.2147/JMDH.S467613.

Analysis of early perioperative outcomes of robot-assisted radical cystectomy and colonic diversion.

Tillu N, Zaytoun O, Kolanukuduru K, Venkatesh A, Dovey Z, Choudhary M J Robot Surg. 2024; 18(1):286.

PMID: 39025997 DOI: 10.1007/s11701-024-02047-w.

References

Fried L, Borhani N, Enright P, Furberg C, Gardin J, Kronmal R . The Cardiovascular Health Study: design and rationale. Ann Epidemiol. 1991; 1(3):263-76. DOI: 10.1016/1047-2797(91)90005-w. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

Shlipak M, Sarnak M, Katz R, Fried L, Seliger S, Newman A . Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005; 352(20):2049-60. DOI: 10.1056/NEJMoa043161. View

Dinits-Pensy M, Forrest G, Cross A, Hise M . The use of vaccines in adult patients with renal disease. Am J Kidney Dis. 2005; 46(6):997-1011. DOI: 10.1053/j.ajkd.2005.08.032. View

Sarnak M, Katz R, Stehman-Breen C, Fried L, Jenny N, Psaty B . Cystatin C concentration as a risk factor for heart failure in older adults. Ann Intern Med. 2005; 142(7):497-505. DOI: 10.7326/0003-4819-142-7-200504050-00008. View

Girndt M, Sester M, Sester U, Kaul H, Kohler H . Molecular aspects of T- and B-cell function in uremia. Kidney Int Suppl. 2001; 78:S206-11. DOI: 10.1046/j.1523-1755.2001.59780206.x. View

Vanholder R, Ringoir S . Infectious morbidity and defects of phagocytic function in end-stage renal disease: a review. J Am Soc Nephrol. 1993; 3(9):1541-54. DOI: 10.1681/ASN.V391541. View

Pesanti E . Immunologic defects and vaccination in patients with chronic renal failure. Infect Dis Clin North Am. 2001; 15(3):813-32. DOI: 10.1016/s0891-5520(05)70174-4. View

Vinge E, Lindergard B, Nilsson-Ehle P, Grubb A . Relationships among serum cystatin C, serum creatinine, lean tissue mass and glomerular filtration rate in healthy adults. Scand J Clin Lab Invest. 2000; 59(8):587-92. DOI: 10.1080/00365519950185076. View

10.

Go A, Chertow G, Fan D, McCulloch C, Hsu C . Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004; 351(13):1296-305. DOI: 10.1056/NEJMoa041031. View

11.

Shlipak M, Katz R, Cushman M, Sarnak M, Stehman-Breen C, Psaty B . Cystatin-C and inflammatory markers in the ambulatory elderly. Am J Med. 2005; 118(12):1416. DOI: 10.1016/j.amjmed.2005.07.060. View

12.

Allon M, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne D . The spectrum of infection-related morbidity in hospitalized haemodialysis patients. Nephrol Dial Transplant. 2005; 20(6):1180-6. DOI: 10.1093/ndt/gfh729. View

13.

Dalrymple L, Johansen K, Chertow G, Cheng S, Grimes B, Gold E . Infection-related hospitalizations in older patients with ESRD. Am J Kidney Dis. 2010; 56(3):522-30. PMC: 2926212. DOI: 10.1053/j.ajkd.2010.04.016. View

14.

Cushman M, Cornell E, Howard P, Bovill E, Tracy R . Laboratory methods and quality assurance in the Cardiovascular Health Study. Clin Chem. 1995; 41(2):264-70. View

15.

Chonchol M . Neutrophil dysfunction and infection risk in end-stage renal disease. Semin Dial. 2006; 19(4):291-6. DOI: 10.1111/j.1525-139X.2006.00175.x. View

16.

Allon M, Depner T, Radeva M, Bailey J, Beddhu S, Butterly D . Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol. 2003; 14(7):1863-70. DOI: 10.1097/01.asn.0000074237.78764.d1. View

17.

James M, Quan H, Tonelli M, Manns B, Faris P, Laupland K . CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis. 2009; 54(1):24-32. DOI: 10.1053/j.ajkd.2009.04.005. View

18.

Fried L, Katz R, Sarnak M, Shlipak M, Chaves P, Jenny N . Kidney function as a predictor of noncardiovascular mortality. J Am Soc Nephrol. 2005; 16(12):3728-35. DOI: 10.1681/ASN.2005040384. View

19.

Tell G, Fried L, Hermanson B, Manolio T, Newman A, Borhani N . Recruitment of adults 65 years and older as participants in the Cardiovascular Health Study. Ann Epidemiol. 1993; 3(4):358-66. DOI: 10.1016/1047-2797(93)90062-9. View

20.

Jenny N, Tracy R, Ogg M, Luong L, Kuller L, Arnold A . In the elderly, interleukin-6 plasma levels and the -174G>C polymorphism are associated with the development of cardiovascular disease. Arterioscler Thromb Vasc Biol. 2002; 22(12):2066-71. DOI: 10.1161/01.atv.0000040224.49362.60. View