CKD ups mortality in infection-related hospitalization
Chronic kidney disease (CKD) is associated with poorer in-hospital outcomes in infection-related hospitalization (IRH) patients, a new study from China has found.
“Our study is the first to quantify the spectrum of infections and associated in-hospital outcomes of IRH in patients with and without CKD in China,” said researchers.
“We report that CKD patients hospitalized with infections have increased rates of deaths and intensive care unit (ICU) admissions, resulting in higher health care resource consumption,” they added.
In the study sample of 6,283 IRH patients (median age 63 [49 to 77] years; 49.7 percent female), 1,935 had CKD while 4,348 did not. Community-acquired IRHs (CAIRH; 58.8 percent; n=3,697) constituted most of the IRH cases. This was followed by undefined (UIRH; 37.7 percent; n=2,371) and healthcare-acquired (HAIRH, 2.6 percent; n=162) IRH cases. Patients with both CAIRH and HAIRH were the smallest proportion (0.8 percent; n=53). [Sci Rep 2017;7:11530]
The mortality rate in the CKD and non-CKD patients was calculated to be 5.9 (n=115) and 3.8 (n=166) percent, respectively, with the difference reaching statistical significance (p<0.001). In the fully adjusted model, the odds of in-hospital death were significantly higher in CKD than in non-CKD patients (odds ratio [OR], 1.41; 95 percent CI, 1.02 to 1.96; p=0.04).
Analysis of the CAIRH subgroup showed that CKD also elevated the risk of in-hospital death, although the effect did not reach significance (OR, 1.34; 0.86 to 2.09; p=0.20). In contrast, CKD insignificantly decreased the risk of mortality in HAIRH patients (OR, 0.87; 0.27 to 2.70; p=0.79).
While the detrimental effect of CKD on the mortality of IRH patients might be explained by older age and other comorbidities, controlling for these did not affect the interaction, suggesting that other factors were involved.
These factors may include “poorer responses to treatment, immune dysfunction with increased susceptibility to infections, and a higher incidence of dehydration that may induce acute kidney injury during infection,” according to the researchers. [Adv Chronic Kidney Dis 2006;13:199-204; Clin J Am Soc Nephro 2008;3:1526-1533]
Admission into the ICU was also higher in CKD patients than in non-CKD patients (12.2 vs 5.5 percent). This was true across the overall sample (OR, 2.18; 1.64 to 2.91; p<0.001), among CAIRH patients (OR, 2.01; 1.34 to 3.02; p=0.001) and among HAIRH patients (OR, 2.48; 1.08 to 5.70; p=0.03), even after adjusting for age, sex and comorbidities. Adjusting for pneumonia did not attenuate the statistically significant interactions.
Moreover, CKD patients had significantly longer duration of stay than non-CKD patients (median length 11 vs 10 days; p<0.001). CKD patients also incurred a 20-percent increase in total medical expenses compared with non-CKD patients.
“In conclusion, our findings highlight the poorer clinical outcomes and higher healthcare resource consumption of hospitalizations for patients with infections who also have CKD,” summarized researchers.
“For patients with CKD, infection prevention strategies should focus on respiratory tract infections and genitourinary tract infections. These patients need to be carefully monitored to prevent modifiable adverse outcomes,” they recommended.