Abstract
Background Hospital admissions for community-acquired infection are increasing rapidly in the United Kingdom, particularly among older individuals, possibly reflecting an increasing prevalence of comorbid conditions such as chronic kidney disease (CKD). This study describes associations between CKD (excluding patients treated by dialysis or transplantation) and community-acquired infection incidence among older people with diabetes mellitus. Study Design Retrospective cohort study using primary care records from the Clinical Practice Research Datalink linked to Hospital Episode Statistics admissions data. Setting & Participants 191,709 patients 65 years or older with diabetes mellitus and no history of renal replacement therapy, United Kingdom, 1997 to 2011. Predictor Estimated glomerular filtration rate (eGFR) and history of proteinuria. Outcomes Incidence of community-acquired lower respiratory tract infections (LRTIs, with pneumonia as a subset) and sepsis, diagnosed in primary or secondary care, excluding hospital admissions from time at risk. Measurements Poisson regression was used to calculate incidence rate ratios (IRRs) adjusted for age, sex, smoking status, comorbid conditions, and characteristics of diabetes. Estimates for associations of eGFR with infection were adjusted for proteinuria, and vice versa. Results Strong graded associations between lower eGFRs and infection were observed. Compared with patients with eGFRs 60 mL/min/1.73 m2, fully adjusted IRRs for pneumonia among those with eGFRs < 15, 15 to 29, 30 to 44, and 45 to 59 mL/min/1.73 m2 were 3.04 (95% CI, 2.42-3.83), 1.73 (95% CI, 1.57-1.92), 1.19 (95% CI, 1.11-1.28), and 0.95 (95% CI, 0.89-1.01), respectively. Associations between lower eGFRs and sepsis were stronger, with fully adjusted IRRs up to 5.56 (95% CI, 3.90-7.94). Those associations with LRTI were weaker but still clinically relevant at up to 1.47 (95% CI, 1.34-1.62). In fully adjusted models, a history of proteinuria remained an independent marker of increased infection risk for LRTI, pneumonia, and sepsis (IRRs of 1.07 [95% CI, 1.05-1.09], 1.26 [95% CI, 1.19-1.33], and 1.33 [95% CI, 1.20-1.47]). Limitations Patients without creatinine results were excluded. Conclusions Strategies to prevent infection among people with CKD are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 60-68 |
| Number of pages | 9 |
| Journal | American Journal of Kidney Diseases |
| Volume | 66 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 1 Jul 2015 |
| Externally published | Yes |
Bibliographical note
Funding Information:Support: Dr Thomas reports a Career Development Fellowship grant (CDF 2010-03-32) from the National Institute for Health Research during the conduct of the study. Dr McDonald reports a PhD studentship grant from Kidney Research UK (grant reference ST2/2011) during the conduct of the study, for which Drs Thomas and Nitsch wrote the studentship application. The study sponsors had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of data; the preparation, review, or approval of the manuscript; or the decision to submit it for publication. The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service, the National Institute for Health Research, the Department of Health, or Kidney Research UK.
Publisher Copyright:
© 2015 National Kidney Foundation, Inc.
Funding
Support: Dr Thomas reports a Career Development Fellowship grant (CDF 2010-03-32) from the National Institute for Health Research during the conduct of the study. Dr McDonald reports a PhD studentship grant from Kidney Research UK (grant reference ST2/2011) during the conduct of the study, for which Drs Thomas and Nitsch wrote the studentship application. The study sponsors had no role in the design or conduct of the study; the collection, management, analysis, or interpretation of data; the preparation, review, or approval of the manuscript; or the decision to submit it for publication. The views expressed in this publication are those of the authors and not necessarily those of the UK National Health Service, the National Institute for Health Research, the Department of Health, or Kidney Research UK.
Keywords
- aged
- Community-acquired infections
- decreased renal function
- diabetes mellitus
- elderly
- electronic health records
- estimated glomerular filtration rate (EGFR)
- lower respiratory tract infections (LRTIs)
- non-dialysis-dependent chronic kidney disease (CKD)
- pneumonia
- proteinuria
- sepsis
ASJC Scopus subject areas
- Nephrology
