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Impact of Renal Failure on the Outcome of Dengue Viral Infection

Mei-Chuan Kuo^*,, Po-Liang Lu^,, Jer-Ming Chang^,||, Ming-Yen Lin^*, Jih-Jin Tsai^,, Yen-Hsu Chen^,, Ko Chang^||, Hung-Chun Chen^*,, and Shang-Jyh Hwang^*,

Divisions of ^* Nephrology and Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Faculties of Renal Care and Medicine, College of Medicine, Kaohsiung Medical University, and ^|| Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Correspondence: Dr. Shang-Jyh Hwang, Division of Nephrology, Department of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan. Phone: 886-3121101, ext. 7901; Fax: 886-7-3165706; E-mail: sjhwang{at}kmu.edu.tw

Background and objectives: In the 2002 dengue outbreak in Taiwan, some fatal cases had the underlying disease of renal failure (RF). Physicians faced difficulty in diagnosis and treatment of these patients; however, the impacts of RF on the clinical presentations and outcomes of dengue infection have not been reported previously.

Design, setting, participants, & measurements: A retrospective review was conducted of medical records, clinical presentations, laboratory findings, and underlying diseases for all cases of dengue infection in a medical center. Characteristics and outcomes of dengue-infected patients with and without RF were compared.

Results: From January 2002 through January 2003, 519 dengue-infected patients were enrolled, including 412 patients with classical dengue fever (DF) and 107 patients with dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Twelve patients died in this outbreak, and all had DHF/DSS. Twenty-one (4.0%) patients were defined as being in the RF group. The RF group had a higher mortality rate than non-RF group (28.6 versus 1.2%; P < 0.001). The severity of GFR impairment was associated with higher percentages of DHF/DSS (P = 0.029) and mortality (P < 0.001). Differences in symptoms/signs and laboratory abnormalities between DF and DHF/DSS were significant in the non-RF group but not apparent in the RF group.

Conclusions: The diagnosis and management of dengue infection among patients with RF must be cautious, because complicated clinical courses with a higher mortality rate were well observed.