Kidney Week

Abstract: FR-PO0248

Superficial Fungal Infection and Clinical Outcomes in Patients with CKD

Session Information

• CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Hirano, Keita, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

Keita Hirano, MD, PhD

• Ishigami, Junichi, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States

Junichi Ishigami, MD, MPH

• Sumida, Keiichi, Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima, Japan

Keiichi Sumida, MD, PhD, MPH, FASN

• Fukuma, Shingo, Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan

Shingo Fukuma, MD, PhD

Background

Superficial fungal infection is common in patients with chronic kidney disease (CKD), particularly those with ESKD, possibly due in part to impaired immune function. However, the clinical implications of superficial fungal infection in CKD remain unclear.

Methods

In a retrospective nationwide Japanese cohort study using linked health checkup and claims data, we identified adults with CKD,
defined as the first health checkup with eGFR <60 mL/min/1.73 m². We examined the association between superficial fungal infection and clinical outcomes using a 180-day landmark design. Incident superficial fungal infections were identified during the 180 days following the index date, after which follow-up started. Outcomes included all-cause death, cardiovascular disease (CVD) hospitalization, and infection-related hospitalization (as primary), and a 40% eGFR decline (as secondary). Associations were assessed using multivariable Cox models adjusted for demographics, baseline eGFR, cardiometabolic factors, medication use, and healthcare utilization.

Results

Among 813,727 patients with CKD, 16,117 developed superficial fungal infection during the landmark period. Over a median follow-up of 5.0 years, 27,862 deaths, 58,014 CVD hospitalizations, and 43,315 infection-related hospitalizations occurred. Patients with (vs. without) superficial fungal infection had higher 5-year crude risks for all-cause death (5.2% vs 3.4%), CVD hospitalization (10.8% vs 7.1%), and infection-related hospitalization (8.4% vs 5.3%). After multivariable adjustment, superficial fungal infection was significantly associated with higher risks of all-cause death (adjusted HR 1.17 [95% CI, 1.08–1.25]), CVD hospitalization (1.20 [1.14–1.26]) and infection-related hospitalization (1.24 [1.17–1.31]) (Figure). No significant association was observed between superficial fungal infection and a 40% eGFR decline.

Conclusion

In patients with CKD, superficial fungal infection was independently associated with higher subsequent risks of all-cause death, CVD hospitalization, and infection-related hospitalization.