Infection-Related Acute Care Events among Patients with Glomerular Disease

Abstract

Background and objectives: Infections contribute to patient morbidity and mortality in glomerular disease. We sought to describe the incidence of, and identify risk factors for, infection-related acute care events among Cure Glomerulonephropathy Network (CureGN) study participants.

Design, setting, participants, & measurements: CureGN is a prospective, multicenter, cohort study of children and adults with biopsy sample-proven minimal change disease, FSGS, membranous nephropathy, or IgA nephropathy/vasculitis. Risk factors for time to first infection-related acute care events (hospitalization or emergency department visit) were identified using multivariable Cox proportional hazards regression.

Results: Of 1741 participants (43% female, 41% <18 years, 68% White), 163 (9%) experienced infection-related acute care events over a median follow-up of 17 months (interquartile range, 9-26 months). Unadjusted incidence rates of infection-related acute care events were 13.2 and 6.2 events per 100 person-years among pediatric and adult participants, respectively. Among participants with versus without corticosteroid exposure at enrollment, unadjusted incidence rates were 50.6 and 28.6 per 100 person-years, respectively, during the first year of follow-up (adjusted hazard ratio for time to first infection, 1.31; 95% CI, 0.89 to 1.93), and 4.1 and 1.1 per 100 person-years, respectively, after 1 year of follow-up (hazard ratio, 2.99; 95% CI, 1.54 to 5.79). Hypoalbuminemia combined with nephrotic-range proteinuria (serum albumin ≤2.5 g/dl and urinary protein-creatinine ratio >3.5 mg/mg), compared with serum albumin >2.5 g/dl and urinary protein-creatinine ratio ≤3.5 mg/mg, was associated with higher risk of time to first infection (adjusted hazard ratio, 2.49; 95% CI, 1.51 to 4.12).

Conclusions: Among CureGN participants, infection-related acute care events were common and associated with younger age, corticosteroid exposure, and hypoalbuminemia with proteinuria.

Keywords: acute care events; glomerular disease; hospitalization; immunosuppression; infection; kidney disease; nephrotic syndrome; pediatric nephrology.

Graphical abstract

Figure 1.

Flow chart illustrating participants and data used for analyses of infection-related acute care events from the Cure Glomerulonephropathy Network (CureGN) study. UPCR, urinary protein-creatinine ratio.

Figure 2.

Time to first infection-related acute care event stratified by age and UPCR/albumin category. A, serum albumin; U, urine protein-creatinine ratio.

Figure 3.

Rates of infectious events per 100 person-years in the CureGN cohort relative to rates from published studies in patients with CKD, GN, and the general population. When appropriate, incidence rates were calculated from reported cumulative incidence rates using the formula CI=1–e^(−IR×T). IgAN, IgA nephropathy; Peds, pediatric patients; Pts, patients; USRDS, United States Renal Data System; CI, cummulative incidence; IR, incidence rate; T, time; ARIC, Atherosclerosis Risk in Communities Study; GDCN, Glomerular Disease Collaborative Network.