Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro.
Mayo Clin Proc. 2020 Sep;95(9):1928-1939. doi: 10.1016/j.mayocp.2020.02.026. Epub 2020 Aug 6.
To evaluate whether the incidence of infectious diseases increases the long-term risk for incident end-stage renal disease (ESRD) in the general population.
In 10,290 participants of the Atherosclerosis Risk in Communities Study who attended visit 4 (1996-1998), we evaluated the association of incident hospitalization with major infections (pneumonia, urinary tract infection, bloodstream infection, and cellulitis and osteomyelitis) with subsequent risk for ESRD through September 30, 2015. Hospitalization with major infection was entered into multivariable Cox models as a time-varying exposure to estimate the hazard ratios.
Mean age was 63 years, and of 10,290 individuals, 56% (n=5781) were women, 22% (n=2252) were black, and 7% (n=666) had an estimated glomerular filtration rate less than 60 mL/min/1.73 m. During a median follow-up of 17.4 years, there were 2642 incident hospitalizations with major infection and 281 cases of ESRD (132 cases after hospitalization with major infection). The risk for ESRD was higher following major infection compared with while free of major infection (crude incidence rate, 10.9 vs 1.0 per 1000 person-years). In multivariable time-varying Cox analysis, hospitalization with major infection was associated with a 3.3-fold increased risk for ESRD (hazard ratio, 3.34; 95% CI, 2.56-4.37). The association was similar across pneumonia, urinary tract infection, bloodstream infection, and cellulitis and osteomyelitis, and remained significant across subgroups of age, sex, race, diabetes, history of cardiovascular disease, and chronic kidney disease.
Hospitalization with major infection was independently and robustly associated with subsequent risk for ESRD. Whether preventive approaches against infection have beneficial effects on kidney outcomes may deserve future investigations.
评估传染病的发病率是否会增加普通人群中终末期肾脏疾病（ESRD）的发病风险。
在参加 1996-1998 年第四次（ARIC）访问的 10290 名社区动脉粥样硬化风险研究（ARIC）参与者中，我们评估了主要感染（肺炎、尿路感染、血流感染、蜂窝织炎和骨髓炎）的住院与随后发生 ESRD 的风险之间的关系，随访至 2015 年 9 月 30 日。将主要感染住院作为时变暴露因素纳入多变量 Cox 模型，以估计风险比。
平均年龄为 63 岁，10290 名个体中 56%（n=5781）为女性，22%（n=2252）为黑人，7%（n=666）估算肾小球滤过率低于 60 mL/min/1.73 m。在中位随访 17.4 年期间，有 2642 例主要感染住院，281 例发生 ESRD（281 例中有 132 例发生在主要感染住院后）。与无主要感染相比，发生主要感染后的 ESRD 风险更高（粗发病率，10.9 与 1.0 每 1000 人年）。在多变量时变 Cox 分析中，主要感染住院与 ESRD 风险增加 3.3 倍相关（风险比，3.34；95%CI，2.56-4.37）。在肺炎、尿路感染、血流感染、蜂窝织炎和骨髓炎中，这种关联相似，在年龄、性别、种族、糖尿病、心血管疾病史和慢性肾脏病等亚组中，这种关联仍然显著。
主要感染的住院与随后发生 ESRD 的风险独立且显著相关。针对感染的预防方法是否对肾脏结局有有益影响，可能值得未来的研究。
