eGFR and the Risk of Community-Acquired Infections

Abstract

Background and objectives: Community-acquired infections are common, contributing to adverse outcomes and increased health care costs. We hypothesized that, with lower eGFR, the incidence of community-acquired infections increases, whereas the pattern of site-specific infections varies.

Design, setting, participants, & measurements: Among 1,139,470 health care users (mean age =52±18 years old, 53% women) from the Stockholm CREAtinine Measurements Project, we quantified the associations of eGFR with the risk of infections, overall and major types, over 12 months.

Results: A total of 106,807 counts of infections were recorded throughout 1,128,313 person-years. The incidence rate of all infections increased with lower eGFR from 74/1000 person-years for individuals with eGFR=90-104 ml/min per 1.73 m² to 419/1000 person-years for individuals with eGFR<30 ml/min per 1.73 m². Compared with eGFR of 90-104 ml/min per 1.73 m², the adjusted incidence rate ratios of community-acquired infections were 1.08 (95% confidence interval, 1.01 to 1.14) for eGFR of 30-59 ml/min per 1.73 m² and 1.53 (95% confidence interval, 1.39 to 1.69) for eGFR<30 ml/min per 1.73 m². The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis became increasingly higher along with lower eGFR strata (e.g., low respiratory tract infection accounting for 25% versus 15% of community-acquired infections in eGFR<30 versus 90-104 ml/min per 1.73 m², respectively). Differences in incidence associated with eGFR were in general consistent for most infection types, except for nervous system and upper respiratory tract infections, for which no association was observed.

Conclusions: This region-representative health care study finds an excess community-acquired infections incidence in individuals with mild to severe CKD. Lower respiratory tract infection, urinary tract infection, and sepsis are major infections in CKD.

Keywords: Adult; Aged; Communicable Diseases; Community-Acquired Infections; Epidemiology and outcomes; Female; Health Care Costs; Humans; Incidence; Middle Aged; Nervous System; Renal Insufficiency, Chronic; Respiratory Tract Infections; Urinary Tract Infections; chronic kidney disease; community; creatinine; glomerular filtration rate; lower respiratory tract infection; renal function; risk factors; sepsis; urinary tract infections.

Figure 1.

Increased incidence rate of type-specific infections across eGFR categories within 12 months of follow-up.

Figure 2.

Different relative percentage for incidence rates of type-specific infections by eGFR categories within 12 months of follow-up. A shows the five most common infection types (those with an incidence rate ≥10/1000 person-years), and the remaining minority types were grouped under the category other. B expands the relative percentage of the less common infection types (those with an incidence rate <10/1000 person-years) grouped as other in A.

Figure 3.

Increased incidence rate ratio (IRR) and 95% confidence intervals (CI) for type-specific community-acquired infections across eGFR categories within 12 months of follow-up. IRRs were adjusted for age, sex, use of immunosuppressive drugs, prior anti-infection drugs (antibiotics, antimycotics, and antivirals), comorbidities (cardiovascular disease, dementia, chronic pulmonary disease, rheumatic disease, peptic ulcer disease, liver disease, hemiplegia or paraplegia, cancer, diabetes, and hypertension), and exposure time.