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Epidemiology of Acute Infections among Patients with Chronic Kidney Disease

Lorien S. Dalrymple^*, and Alan S. Go

^* Department of Internal Medicine, Division of Nephrology, University of California at Davis, Sacramento, and Division of Research, Kaiser Permanente of Northern California, Oakland, and Departments of Epidemiology, Biostatistics, and Medicine, University of California at San Francisco, San Francisco, California

Correspondence: Dr. Lorien S. Dalrymple, Department of Internal Medicine, Division of Nephrology, University of California, Davis, 4150 V Street, #3500 PSSB, Sacramento, CA 95817. Phone: 916-734-3774; Fax: 916-734-7920; E-mail: lorien.dalrymple{at}ucdmc.ucdavis.edu

The objectives of this review were (1) to review recent literature on the rates, risk factors, and outcomes of infections in patients who had chronic kidney disease (CKD) and did or did not require renal replacement therapy; (2) to review literature on the efficacy and use of selected vaccines for patients with CKD; and (3) to outline a research framework for examining key issues regarding infections in patients with CKD. Infection-related hospitalizations contribute substantially to excess morbidity and mortality in patients with ESRD, and infection is the second leading cause of death in this population. Patients who have CKD and do not require renal replacement therapy seem to be at higher risk for infection compared with patients without CKD; however, data about patients who have CKD and do not require dialysis therapy are very limited. Numerous factors potentially predispose patients with CKD to infection: advanced age, presence of coexisting illnesses, vaccine hyporesponsiveness, immunosuppressive therapy, uremia, dialysis access, and the dialysis procedure. Targeted vaccination seems to have variable efficacy in the setting of CKD and is generally underused in this population. In conclusion, infection is a primary issue when caring for patients who receive maintenance dialysis. Very limited data exist about the rates, risk factors, and outcomes of infection in patients who have CKD and do not require dialysis. Future research is needed to delineate accurately the epidemiology of infections in these populations and to develop effective preventive strategies across the spectrum of CKD severity.