Risk of Development of Chronic Kidney Disease After Exposure to Borrelia burgdorferi and Anaplasma spp

Abstract

Lyme disease is a multi-faceted illness caused by infection due to Borrelia burgdorferi. Acute kidney damage secondary to Lyme disease is well described but less so as a chronic event. The role of Anaplasma spp. and secondary kidney dysfunction is not known. A retrospective cohort study was performed to determine if dogs within a defined Lyme disease and anaplasmosis region with B. burgdorferi or Anaplasma spp. antibodies had an increased risk of chronic kidney disease (CKD). Patient exposure was defined as having a B. burgdorferi or Anaplasma spp. antibody positive result recorded at any point in the available patient history. CKD was defined as concurrent increased symmetric dimethylarginine and creatinine (Cr) for a minimum of 25 days with inappropriate urine specific gravity (USG). Patients were matched using propensity scoring to control for age, region, and breed. Contingency tables were used to compare dogs seropositive and not seropositive to B. burgdorferi and Anaplasma spp. and CKD outcome. For each comparison that was performed, statistical significance was defined by a P-value of <.025. The risk ratio of CKD for patients exposed to B. burgdorferi and Anaplasma spp. were found to be 1.43 (95% confidence interval [CI, 1.27, 1.61], P < .0001) and 1.04, (95% CI [0.87, 1.24], P = .6485), respectively. Results suggest in this cohort no increased risk for developing CKD when exposed to Anaplasma spp. but a significant increase in risk for developing CKD with exposure to B. burgdorferi.

Keywords: Anaplasma; Borrelia burgdorferi; Chronic Kidney Disease; creatinine; risk ratio; symmetric dimethylarginine.