Sundin Per-Ola, Udumyan Ruzan, Fall Katja, Montgomery Scott
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden,
Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Clin Epidemiol. 2018 Aug 14;10:971-979. doi: 10.2147/CLEP.S169039. eCollection 2018.
Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD).
Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into ≤5, >5-≤15, and >15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31,2009, whichever occurred first.
During a median follow-up of 36.7 (interquartile range 35.3-37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41-20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91-6.93) and then attenuated with increasing time.
Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions.
尽管与包括肺炎在内的严重感染相关的急性肾并发症已得到充分描述，但对于随后可能出现的慢性肾脏病（CKD）延迟风险却知之甚少。
在瑞典所有1952年至1956年出生的男性居民队列（n = 284,198）中，评估成年期因肺炎住院与随后CKD风险增加之间的关联。这些男性在青春期后期参加了义务兵役检查（n = 264,951），并随访至2009年。使用瑞典国家登记册确定CKD和肺炎，并使用Cox回归评估它们之间的关联。排除第一年，随后的时期分为肺炎住院后≤5年、>5至≤15年以及>15年。随访在首次发生肾病诊断、死亡、移民或2009年12月31日（以先发生者为准）时结束。
从青春期后期开始，中位随访36.7年（四分位间距35.3 - 37.9年），5822名男性有住院肺炎诊断且当时无肾病。在暴露男性中，136名（2.3%）后来被诊断为CKD，而未暴露男性中为2749名（1.2%）。肺炎首次发作后第一年CKD的调整后风险比为14.55（95%置信区间，10.41 - 20.32），表明存在早期肾并发症以及可能先前未诊断出的CKD。在肺炎发生1年后开始随访以减少监测偏倚的潜在影响和反向因果关系的风险，随访前5年CKD的调整后风险比为5.20（95%置信区间，3.91 - 6.93），然后随着时间增加而减弱。
住院患者的肺炎与随后CKD的持续风险增加相关，在肺炎后的头几年风险最高。医疗保健专业人员应意识到这一高风险期，以便于早期诊断和二级预防干预。
