title: Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality.
abstract: The risk of infection in advanced chronic kidney disease (CKD) and its subsequent impact on adverse outcomes are not well established. Therefore, we determined the association of an infectious episode with the subsequent risk of cardiovascular ischemia, congestive heart failure, end-stage kidney disease or mortality in a Canadian prospective cohort (CanPREDDICT) of patients with advanced CKD (eGFR: 15-45 ml/min/1.73m(2)) followed by nephrologists for up to 5 years. Infectious episodes were classified by anatomic location and identified by positive culture, hospital admission, or use of antibiotics. Competing risk models were used to examine the time-varying risk of infection and the risk of cardiovascular ischemia, congestive heart failure, or end-stage kidney disease accounting for the competing risk of mortality. All outcomes were independently adjudicated. Of 2370 patients (mean age, 68 years; mean baseline eGFR, 28.2 mL/min/1.73m(2)), 575 patients (24.3%) had recorded infections; 378 had 1 infection episode, whereas 197 had 2 or more episodes, the most common being urinary and respiratory. An infectious episode was independently associated with an increased risk of cardiovascular ischemia (hazard ratio 1.80, 95% confidence interval 1.24-2.60), congestive heart failure (hazard ratio, 3.2; confidence interval, 2.25-4.61), end-stage kidney disease (hazard ratio, 1.58; confidence interval, 1.22-2.05) or mortality (hazard ratio, 3.39; confidence interval, 2.65-4.33). Thus, there is a high risk of infection in advanced CKD being associated with subsequent adverse outcomes.
authors: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Hicham I
authors: HI
authors: Cheikh Hassan
authors: British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada.
authors: Mila
authors: M
authors: Tang
authors: British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada.
authors: Ognjenka
authors: O
authors: Djurdjev
authors: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: David
authors: D
authors: Langsford
authors: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. Electronic address: msood99@gmail.com.
authors: Manish M
authors: MM
authors: Sood
authors: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada. Electronic address: alevin@providencehealth.bc.ca.
authors: Adeera
authors: A
authors: Levin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D003141:Communicable Diseases / Q000150:complications* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors
keywords: cardiac ischemia; chronic kidney disease; competing risks infection; congestive heart failure; dialysis; mortality