Original Investigation
Pathogenesis and Treatment of Kidney Disease
The Risk of Infection-Related Hospitalization With Decreased Kidney Function

https://doi.org/10.1053/j.ajkd.2011.07.012Get rights and content

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 m2 at enrollment.

Predictor

The primary exposure of interest was eGFR using serum cystatin C level (eGFRSCysC).

Outcome

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

Results

In adjusted analyses, eGFRSCysC categories of 60-89, 45-59, and 15-44 mL/min/1.73 m2 were associated with 16%, 37%, and 64% greater risk of all-cause infection-related hospitalization, respectively, compared with eGFRSCysC ≥90 mL/min/1.73 m2. When cause-specific infection was examined, eGFRSCysC of 15-44 mL/min/1.73 m2 was associated with an 80% greater risk of pulmonary and 160% greater risk of genitourinary infection compared with eGFRSCysC ≥90 mL/min/1.73 m2.

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.

Section snippets

Study Population

The CHS is a prospective cohort study of community-dwelling adults 65 years or older.10 Participants were randomly sampled from Health Care Financing Administration Medicare eligibility lists in Sacramento County, CA; Allegheny County, PA; Forsyth County, NC; and Washington County, MD. Participants initially were recruited between 1989 and 1990. Exclusion criteria included inability to provide informed consent or communicate with the interviewer, need of a proxy respondent for baseline

Results

Of the 5,888 original CHS participants, 80 were excluded for missing serum creatinine measurements; 651, for missing cystatin C values; and 15, for eGFR <15 mL/min/1.73 m2 or renal replacement therapy, resulting in a final study sample of 5,142. Participants excluded were more likely to be older, men, and nonblack and have prevalent diabetes and cancer and higher hemoglobin, IL-6, serum creatinine, and cystatin C concentrations. Excluded participants had lower body mass index and lower

Discussion

When kidney function was assessed by eGFRSCysC, we found that it was linearly associated with higher risk of infection-related hospitalization. Compared with participants with eGFRSCysC ≥90 mL/min/1.73 m2, participants with stage 3a CKD (eGFRSCysC, 45-59 mL/min/1.73 m2) had a nearly 40% increase in risk of infection-related hospitalization, and participants with stages 3b or 4 CKD (eGFRSCysC, 15-44 mL/min/1.73 m2) had a >60% increase in risk. These findings highlight that even moderately

Acknowledgements

Findings from this study were presented as a Poster Presentation at the American Society of Nephrology Renal Week in Denver, CO, on November 20, 2010.

Support: This research was supported by contracts N01-HC-85239, N01-HC-85079 through N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, and grant HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke.

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