title: CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  Individuals on dialysis therapy have a high risk for infection, but risk for infection in earlier stages of chronic kidney disease has not been comprehensively described.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  9,697 participants (aged 53-75 years) in the Atherosclerosis Risk in Communities (ARIC) Study. Participants were followed up from 1996 to 1998 through 2011.
  
  
  METHODS
  Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR).
  
  
  RESULTS
  Risk for hospitalization with infection and death during or within 30 days of hospitalization with infection.
  
  
  RESULTS
  During follow-up (median, 13.6 years), there were 2,701 incident hospitalizations with infection (incidence rate, 23.6/1,000 person-years) and 523 infection-related deaths. In multivariable analysis, HRs of incident hospitalization with infection as compared to eGFRs≥90mL/min/1.73m2were 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 eGFRs of 15 to 29, 30 to 59, and 60 to 89mL/min/1.73m2, 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 ACRs<10mg/g, 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 ACRs≥300, 30 to 299, and 10 to 29mg/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, bloodstream infections, and cellulitis and when taking into account recurrent episodes of infection.
  
  
  CONCLUSIONS
  Outcome ascertainment relied on diagnostic codes at time of discharge.
  
  
  CONCLUSIONS
  Increasing provider awareness of chronic kidney disease as a risk factor for infection is needed to reduce infection-related morbidity and mortality.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ishigami
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
authors.affiliation: Division of Nephrology, Geisinger Health System, Danville, PA.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Chang
authors.affiliation: Division of Nephrology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Carrero
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: kmatsush@jhsph.edu.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000652:urine; D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality; D002481:Cellulitis / Q000453:epidemiology / Q000401:mortality; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000401:mortality
chemical_list: D003404:Creatinine
keywords: Chronic kidney disease (CKD); albuminuria; bacteremia; cellulitis; chronic kidney failure; chronic renal insufficiency; glomerular filtration rate (GFR); hospitalization; infection; infectious disease; kidney function; pneumonia; proteinuria; respiratory tract infections; urinary tract infections