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Original ArticlesChronic Kidney Disease
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eGFR and the Risk of Community-Acquired Infections

Hong Xu, Alessandro Gasparini, Junichi Ishigami, Khaled Mzayen, Guobin Su, Peter Barany, Johan Ärnlöv, Bengt Lindholm, Carl Gustaf Elinder, Kunihiro Matsushita and Juan Jesús Carrero
CJASN September 2017, 12 (9) 1399-1408; DOI: https://doi.org/10.2215/CJN.00250117
Hong Xu
Departments of *Medical Epidemiology and Biostatistics and
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
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Alessandro Gasparini
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
‡Department of Health Sciences, University of Leicester, Leicester, United Kingdom;
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Junichi Ishigami
§Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Khaled Mzayen
‖Public Health Sciences and
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Guobin Su
‖Public Health Sciences and
¶Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou City, Guangdong Province, China;
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Peter Barany
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
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Johan Ärnlöv
**School of Health and Social Studies, Dalarna University, Falun, Sweden; and
††Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Bengt Lindholm
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
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Carl Gustaf Elinder
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
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Kunihiro Matsushita
§Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Juan Jesús Carrero
Departments of *Medical Epidemiology and Biostatistics and
†Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;
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Abstract

Background and objectives Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies.

Design, setting, participants, & measurements Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months.

Results A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90–104 ml/min per 1.73 m2 to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m2. Compared with eGFR of 90–104 ml/min per 1.73 m2, the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30–59 ml/min per 1.73 m2 and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m2. The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90–104 ml/min per 1.73 m2, respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed.

Conclusions This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.

  • chronic kidney disease
  • Epidemiology and outcomes
  • renal function
  • risk factors
  • urinary tract infections
  • lower respiratory tract infection
  • sepsis
  • community
  • Adult
  • Aged
  • Communicable Diseases
  • Community-Acquired Infections
  • creatinine
  • Female
  • glomerular filtration rate
  • Health Care Costs
  • Humans
  • Incidence
  • Middle Aged
  • Nervous System
  • Renal Insufficiency, Chronic
  • Respiratory Tract Infections
  • Urinary Tract Infections
  • Received January 9, 2017.
  • Accepted May 26, 2017.
  • Copyright © 2017 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 12 (9)
Clinical Journal of the American Society of Nephrology
Vol. 12, Issue 9
September 07, 2017
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eGFR and the Risk of Community-Acquired Infections
Hong Xu, Alessandro Gasparini, Junichi Ishigami, Khaled Mzayen, Guobin Su, Peter Barany, Johan Ärnlöv, Bengt Lindholm, Carl Gustaf Elinder, Kunihiro Matsushita, Juan Jesús Carrero
CJASN Sep 2017, 12 (9) 1399-1408; DOI: 10.2215/CJN.00250117

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eGFR and the Risk of Community-Acquired Infections
Hong Xu, Alessandro Gasparini, Junichi Ishigami, Khaled Mzayen, Guobin Su, Peter Barany, Johan Ärnlöv, Bengt Lindholm, Carl Gustaf Elinder, Kunihiro Matsushita, Juan Jesús Carrero
CJASN Sep 2017, 12 (9) 1399-1408; DOI: 10.2215/CJN.00250117
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Keywords

  • chronic kidney disease
  • epidemiology and outcomes
  • renal function
  • risk factors
  • Urinary Tract Infections
  • lower respiratory tract infection
  • sepsis
  • community
  • Adult
  • aged
  • Communicable Diseases
  • Community-Acquired Infections
  • creatinine
  • female
  • glomerular filtration rate
  • Health Care Costs
  • humans
  • Incidence
  • Middle Aged
  • Nervous System
  • Renal Insufficiency, Chronic
  • Respiratory Tract Infections

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