Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 Mar;59(3):356-63.
doi: 10.1053/j.ajkd.2011.07.012. Epub 2011 Sep 9.

The risk of infection-related hospitalization with decreased kidney function

Lorien S Dalrymple  1 , Ronit Katz, Bryan Kestenbaum, Ian H de Boer, Linda Fried, Mark J Sarnak, Michael G Shlipak
Affiliations

The risk of infection-related hospitalization with decreased kidney function

Lorien S Dalrymple et al. Am J Kidney Dis. 2012 Mar.

Abstract

Background: Moderate kidney disease may predispose to infection. We sought to determine whether decreased kidney function, estimated by serum cystatin C level, was associated with the risk of infection-related hospitalization in older individuals.

Study design: Cohort study.

Setting & participants: 5,142 Cardiovascular Health Study (CHS) participants with measured serum creatinine and cystatin C and without estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m(2) at enrollment.

Predictor: The primary exposure of interest was eGFR using serum cystatin C level (eGFR(SCysC)).

Outcome: Infection-related hospitalizations during a median follow-up of 11.5 years.

Results: In adjusted analyses, eGFR(SCysC) categories of 60-89, 45-59, and 15-44 mL/min/1.73 m(2) were associated with 16%, 37%, and 64% greater risk of all-cause infection-related hospitalization, respectively, compared with eGFR(SCysC) ≥90 mL/min/1.73 m(2). When cause-specific infection was examined, eGFR(SCysC) of 15-44 mL/min/1.73 m(2) was associated with an 80% greater risk of pulmonary and 160% greater risk of genitourinary infection compared with eGFR(SCysC) ≥90 mL/min/1.73 m(2).

Limitations: No measures of urinary protein, study limited to principal discharge diagnosis.

Conclusions: Lower kidney function, estimated using cystatin C level, was associated with a linear and graded risk of infection-related hospitalization. These findings highlight that even moderate degrees of decreased kidney function are associated with clinically significant higher risks of serious infection in older individuals.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Age-Adjusted Rates of All-Cause and Cause-Specific Infection by kidney Function. Age adjusted rates per 100 person-years of all-cause and cause-specific infection by category of serum cystatin C-based eGFR (ml/min/1.73 m2).
Figure 2
Figure 2
The Association between kidney Function and the Risk of Infection-Related Hospitalization. (a) The assocation between serum cystatin C-based eGFR and the risk of all-cause infection-related hospitalization (b) The association between serum creatinine-based estimated glomerular filtration rate as calculated using the CKD-EPI equation and the risk of all-cause infection-related hospitalization
See this image and copyright information in PMC

Comment in

References

    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–1305. - PubMed
    1. Fried LF, Katz R, Sarnak MJ, et al. Kidney Function as a Predictor of Noncardiovascular Mortality. J Am Soc Nephrol. 2005;16(12):3728–3735. - PubMed
    1. Shlipak MG, Sarnak MJ, Katz R, et al. Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med. 2005;352(20):2049–2060. - PubMed
    1. Allon M, Depner TA, Radeva M, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol. 2003;14(7):1863–1870. - PubMed
    1. Allon M, Radeva M, Bailey J, et al. The spectrum of infection-related morbidity in hospitalized haemodialysis patients. Nephrol Dial Transplant. 2005;20(6):1180–1186. - PubMed

Publication types

Grants and funding