title: Risk of pneumonia among patients with chronic kidney disease in outpatient and inpatient settings: a nationwide population-based study.
abstract: Patients with chronic kidney disease (CKD) are more at risk for pneumonia than the general population. Patients with pneumonia are usually treated as outpatients. However, previous studies were conducted on the basis of inpatient pneumonia. This method may underestimate the risk of pneumonia in patients with CKD. Therefore, we investigated the risk of pneumonia among CKD patients in both outpatient and inpatient settings. A total of 15,562 patients with CKD and 62,109 individuals without CKD (matched for age and gender) were taken as subjects in the Longitudinal Health Insurance Database of Taiwan National Insurance from 1996 to 2010. The incidence density rates of inpatient and outpatient pneumonia were calculated. The risk factors associated with pneumonia were analyzed using Cox proportional hazard models with adjustments for confounders. The incidence density rate of pneumonia was 65.6 per 1000 person-years in patients with CKD and 28.4 per 1000 person-years in individuals without CKD. The incidence density rate of inpatient pneumonia was 43.3 per 1000 person-years in patients with CKD and 16.6 per 1000 person-years in individuals without CKD. CKD was associated with increased risk of pneumonia (adjusted hazard ratio [aHR], 1.97; 95% confidence interval [CI], 1.89-2.05; P < 0.001), outpatient pneumonia (aHR, 1.40; 95% CI, 1.31-1.49), and inpatient pneumonia (aHR, 2.17; 95% CI, 2.07-2.29, P < 0.001). Patients' comorbidities, including diabetes, cardiovascular disease (CVD), asthma, and chronic obstructive pulmonary disease (COPD), were independently associated with increased risk of pneumonia.CKD is associated with the increased risk of both outpatient and inpatient pneumonia. This association is independent of comorbid diabetes, CVD, asthma, and COPD.
authors.affiliation: From the Division of Nephrology and Kidney Institute (C-YC, S-MW, C-CL, C-TC, J-HL, I-KW, C-CH), Department of Internal Medicine; College of Medicine (C-YC, S-MW, C-CL, C-TC, J-HL, I-KW, L-CH, C-HM, C-CH); Division of Cardiology (L-CH), Department of Internal Medicine; Management Office for Health Data (C-HM), and Department of Public Health (R-YW), China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Lien-Cheng
authors.initials: LC
authors.lastname: Hsiao
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
authors.forename: Ruey-Yun
authors.initials: RY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology*; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology