Abstract: SA-PO886
Hospitalization with Major Infection and Incidence of ESRD: The Atherosclerosis Risk in Communities (ARIC) Study
Session Information
- CKD: Pharmacoepidemiology
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Ishigami, Junichi, Johns Hopkins School of Public Health, Baltimore, Maryland, United States
- Cowan, Logan T., Georgia Southern University, Statesboro, Georgia, United States
- Demmer, Ryan, University of Minnesota, Minneapolis, Minnesota, United States
- Grams, Morgan, Johns Hopkins University, Baltimore, Maryland, United States
- Lutsey, Pamela L., University of Minnesota, Minneapolis, Minnesota, United States
- Coresh, Josef, Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland, United States
- Matsushita, Kunihiro, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States
Background
Animal studies have suggested deleterious impacts of infection on the kidney. Whether incidence of infection increases long-term risk of incident ESRD has not been systematically evaluated in the general population.
Methods
In 10,293 participants of the ARIC Study who attended visit 4 (1996-1998), we evaluated the association of incident hospitalization with major infection (pneumonia, urinary tract infection, bloodstream infection, and cellulitis/osteomyelitis) with subsequent risk of ESRD. Hospitalization with major infection was entered into multivariable Cox models as a time-varying exposure to estimate the HRs.
Results
The mean age was 63 years, 56% were female, 22% were black, and 7% had eGFR < 60 ml/min/1.73m2. During a median follow-up of 17.4 years, there were 2,910 incident hospitalizations with major infection and 279 cases of ESRD (209 cases after hospitalizations with major infection). The risk of ESRD was higher following major infection compared to while free of major infection (crude incidence rate, 5.0 vs. 0.6 per 1,000 person-years) (Table). In multivariable time-varying Cox analysis, hospitalization with major infection was associated with 3.4-fold increased risk of ESRD (HR, 3.41 [95%CI, 2.61-4.46]) (Table). The association was similar across pneumonia, urinary tract infection, bloodstream infection, and cellulitis/osteomyelitis and stronger among participants with a concurrent diagnosis of acute kidney injury (HR, 4.30 [95%CI, 3.00-6.18]) compared to those without (HR, 2.06 [1.57-2.72]).
Conclusion
Hospitalization with major infection was independently and robustly associated with subsequent risk of ESRD. Whether preventive approaches of infection have beneficial impacts on kidney outcomes may deserve future investigations.
The hazard ratios for incident ESRD
| All major infection (2,910 events) | Pneumonia (1,499 events | Urinary tract infection (1,422 events) | Bloodstream infection (910 events) | Cellulitis and osteomyelitis (602 events) | |
| IR per 1,000 person-years while free of hospitalization | 0.6 (0.5-0.8) | 1.1 (0.9-1.3) | 1.3 (1.1-1.5) | 1.2 (1.1-1.4) | 1.4 (1.3-1.6) |
| IR per 1,000 person-years following hospitalization | 5.0 (4.3-5.7) | 6.0 (5.0-7.1) | 4.6 (3.7-5.6) | 7.5 (6.2-9.2) | 6.8 (5.3-8.8) |
| Hazard ratio (95%CI) | |||||
| Model 1 | 5.20 (4.03-6.72) | 4.31 (3.21-5.78) | 4.05 (3.01-5.45) | 4.72 (3.26-6.83) | 3.69 (2.57-5.28) |
| Model 2 | 3.41 (2.61-4.46) | 2.84 (2.11-3.83) | 2.61 (1.92-3.54) | 3.11 (2.15-4.51) | 2.37 (1.64-3.44) |
Model 1 adjusted for age, sex, race, BMI, smoking, ever drink, education, sBP, anti-HTN, DM, eGFR, ACR, CRP, CVD, COPD and cancer. Model 2 additionally adjusted for incident CVD.
Funding
- NIDDK Support