eGFR and the risk of community-acquired infections

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, &measurementsAmong1, 139, 470health care users (mean age=52±18 years old, 53% women) from the Stockholm CRE Atinine 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 1.73m2 to 419/1000 person-years for individuals with eGFR, <30 ml/min per 1.73 m2. Compared with eGFRof 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 seps is became increasingly higher alongwith lower eGFR strata (e.g., lowrespiratory tract infection accounting for 25% versus 15%of community-acquired infections in eGFR, <30 versus 90–104ml/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.