eGFR and the risk of community-acquired infections
Community-acquired infections are common, associated with adverse outcomes and they therefore increase costs for the healthcare systems. An international team of researchers from renowned institutions including the Karolinska Institute in Stockholm, Sweden, and the Johns Hopkins Bloomberg School of Public Health in Baltimore (US) has now linked eGFR to infections: the lower the eGFR, the higher the incidence of community-acquired infections, especially lower respiratory tract infection, urinary tract infection, and sepsis.
The authors analyzed the data of around 1.1 million health care users with a mean age of 52 years, quantifying the associations of eGFR with the risk of infections, overall and major types, over 12 months.
Around 107,000 infections were recorded throughout approximately 1.1 million person-years. The incidence rate of all infections increased with lower eGFR: from 74/1,000 person-years with an eGFR=90-104 ml/min/1.73 m2 to 419/1,000 person-years for individuals with an eGFR < 30. Compared with an eGFR of 90-104, the adjusted incidence rate ratios of community-acquired infections were 1.08 for an eGFR of 30-59 and 1.53 for an eGFR <30. The relative proportions of lower respiratory tract infection, urinary tract infection, and sepsis all became increasingly higher with lower eGFR strata. For instance, lower respiratory tract infections accounted for 25 % of community-acquired infections in the group of patients with an eGFR <30, versus 15 % in the group with an eGFR of 90-104.
Individuals with mild to severe chronic kidney disease (CKD) have a higher incidence of community-acquired infections. In particular, lower respiratory tract infection, urinary tract infection, and sepsis are important infections in CKD patients.