CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study.
CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study.
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DOI：
10.1053/j.ajkd.2016.09.018
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发表时间：
2017-06
期刊：
影响因子：
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通讯作者：
Matsushita K
中科院分区：
文献类型：
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作者：
Ishigami J;Grams ME;Chang AR;Carrero JJ;Coresh J;Matsushita K
透析患者感染的风险很高，但慢性肾脏病（CKD）早期阶段的感染风险尚未得到全面描述。观察性队列研究。9，697名参与者（年龄53-75岁）参加了社区动脉粥样硬化风险（ARIC）研究。参与者从1996-1998年到2011年进行了随访。估计的肾小球滤过率（eGFR）和尿白蛋白-肌酐比值（ACR）感染住院的风险，以及感染住院期间或30天内的死亡风险。在随访期间（中位数，13.6年），有2，701例感染住院事件（发病率，23.6/1，000人-年）和523例感染相关死亡。在多变量分析中，与eGFR ≥90 ml/min/1.73 m2相比，感染住院事件的HR为2.55 eGFR为15-29、30-59和60-89 ml/min/1.73 m2时，分别为1.48（95% CI，1.43-4.55）、1.48（95% CI，1.28-1.71）和1.07（95% CI，0.98-1.16）。感染相关死亡的相应HR分别为3.76（95% CI，1.48-9.58）、1.62（95% CI，1.20-2.19）和0.99（95% CI，0.80-1.21）。与ACR <10 mg/g相比，ACR ≥300、30-299和10-29 mg/g的感染住院事件的HR分别为2.30（95% CI，1.81-2.91）、1.56（95% CI，1.36-1.78）和1.34（95% CI，1.20-1.50）。感染相关死亡的相应HR分别为3.44（95% CI，2.28-5.19）、1.57（95% CI，1.18-2.09）和1.39（95% CI，1.09-1.78）。当分别评估肺炎、肾脏和尿路感染、血流感染和蜂窝织炎的风险时，以及考虑感染的复发时，结果是一致的。结果的确定依赖于出院时的诊断代码。需要提高提供者对CKD作为感染风险因素的认识，以降低感染相关的发病率和死亡率。
Individuals on dialysis have a high risk of infection, but risk of infection in earlier stages of chronic kidney disease (CKD) has not been comprehensively described. Observational cohort study. 9,697 participants (aged 53–75 years) in the Atherosclerosis Risk in Communities (ARIC) Study. The participants were followed up from 1996–1998 through 2011. Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) Risk of hospitalization with infection, and death during or within 30-days of hospitalization with infection. During follow-up (median, 13.6 years), there were 2,701 incident hospitalizations with infection (incidence rate, 23.6 per 1,000 person-years) and 523 infection-related deaths. In multivariable analysis, the HRs of incident hospitalization with infection as compared to eGFR ≥90 ml/min/1.73 m2 were 2.55 (95% CI, 1.43–4.55), 1.48 (95% CI, 1.28–1.71), and 1.07 (95% CI, 0.98–1.16) for eGFR 15–29, 30–59, and 60–89 ml/min/1.73 m2, respectively. Corresponding HRs were 3.76 (95% CI, 1.48–9.58), 1.62 (95% CI, 1.20–2.19), and 0.99 (95% CI, 0.80–1.21) for infection-related death. Compared to ACR <10 mg/g, the HRs of incident hospitalization with infection were 2.30 (95% CI, 1.81–2.91), 1.56 (95% CI, 1.36–1.78), and 1.34 (95% CI, 1.20–1.50) for ACR ≥300, 30–299, and 10–29 mg/g, respectively. Corresponding HRs were 3.44 (95% CI, 2.28–5.19), 1.57 (95% CI, 1.18–2.09), and 1.39 (95% CI, 1.09–1.78) for infection-related death. Results were consistent when separately assessing risk for pneumonia, kidney and urinary tract infections, blood stream infections, and cellulitis, and when taking into account recurrent episodes of infection. Outcome ascertainment relied on diagnostic codes at time of discharge. Increasing provider awareness of CKD as a risk factor for infection is needed to reduce infection-related morbidity and mortality.