Adverse dengue outcomes in patients with chronic kidney disease: A population-based analysis of 5.8 million individuals from Brazil

Abstract

Background Dengue fever poses a major public health threat in Brazil, particularly among individuals with comorbid conditions. Chronic kidney disease (CKD) is known to impair immune defenses and may predispose patients to worse infectious outcomes, but its impact on dengue has not been comprehensively evaluated at the national level. This study aimed to assess the association between CKD and adverse clinical outcomes of dengue fever. Methods We conducted a population-based analysis using 2024 data from the Brazilian Information System for Notifiable Diseases (SINAN). Patients with a confirmed diagnosis of dengue, based on laboratory or clinical-epidemiological criteria, were included in the study. The cohort was stratified based on their CKD status. Clinical features and outcomes (hospitalization, severe dengue, and death) were compared. Multivariable logistic regression models weighted by inverse probability of treatment weighting (IPTW) were used to estimate adjusted odds ratios (ORs). Results Among 5,837,904 confirmed dengue cases, 30,527 (0.5%) had CKD. Compared to patients without CKD, those with CKD had significantly higher rates of hospitalization (14% vs. 4%), severe dengue (1.6% vs. 0.1%), and death (2.2% vs. 0.1%) (all p < 0.001). In adjusted analyses, CKD was independently associated with increased odds of death (OR = 3.09, 95% CI: 2.66–3.59) and the composite outcome (OR = 1.62, 95% CI: 1.53–1.71). Hematologic and autoimmune comorbidities also conferred increased risk. Conclusion CKD significantly worsens clinical outcomes in dengue fever. These findings highlight the need for early recognition, tailored care, and targeted public health strategies to protect this high-risk population during dengue outbreaks.