Are pre-existing markers of chronic kidney disease associated with short-term mortality following acute community-acquired pneumonia and sepsis? A cohort study among older people with diabetes using electronic health records

Helen I. McDonald, Dorothea Nitsch, Elizabeth R.C. Millett, Alan Sinclair, Sara L. Thomas

Research output: Contribution to journalArticlepeer-review

11 Citations (SciVal)

Abstract

Background. We aimed to examine whether pre-existing impaired estimated glomerular filtration rate (eGFR) and proteinuria were associated with mortality following community-acquired pneumonia or sepsis among people aged ≥65 years with diabetes mellitus, without end-stage renal disease. Methods. Patients were followed up from onset of first community-acquired pneumonia or sepsis episode in a cohort study using large, linked electronic health databases. Follow-up was for up to 90 days, unlimited by hospital discharge. We used generalized linear models with log link, normal distribution and robust standard errors to calculate risk ratios (RRs) for all-cause 28- and 90-day mortality according to two markers of chronic kidney disease: eGFR and proteinuria. Results. All-cause mortality among the 4743 patients with pneumonia was 29.6% after 28 days and 37.4% after 90 days. Among the 1058 patients with sepsis, all-cause 28- and 90-day mortality were 35.6 and 44.2%, respectively. eGFR <30 mL/min/1.73 m2 was a risk marker of higher 28-day mortality for pneumonia (RR 1.27: 95% CI 1.12-1.43) and sepsis (RR 1.32: 95% CI 1.07-1.64), adjusted for age, sex, socio-economic status, smoking status and co-morbidities. Neither moderately impaired eGFR nor proteinuria were associated with short-term mortality following either infection. Conclusions. People with pre-existing low eGFR but not on dialysis are at higher risk of death following pneumonia and sepsis. This association was not explained by existing co-morbidities. These patients need to be carefully monitored to prevent modifiable causes of death.

Original languageEnglish
Pages (from-to)1002-1009
Number of pages8
JournalNephrology Dialysis Transplantation
Volume30
Issue number6
DOIs
Publication statusPublished - 1 Jun 2015
Externally publishedYes

Keywords

  • chronic kidney disease
  • community-acquired infections
  • electronic health records
  • infection/mortality
  • proteinuria

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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