Oh Hyung Jung, Kim Jung Ho, Lee Kyu-Na, Ahn Jin Young, Jeong Su Jin, Choi Jun Yong, Yeom Joon-Sup, Han Kyungdo, Ku Nam Su
Department of nephrology, Sheik Khalifa Specialty Hospital, Ras Al Khaimah United Arab Emirates.
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Eur J Prev Cardiol. 2025 Jul 25. doi: 10.1093/eurjpc/zwaf430.
The association between chronic kidney disease (CKD) and/or proteinuria and the risk of infective endocarditis (IE) in patients with CKD without replacement therapy remains unclear. This study evaluated the effect of CKD and/or proteinuria on the risk of IE among patients with diabetes.
In this nationwide population-based cohort study, data on patients with diabetes who underwent a health checkup in 2009 were obtained from the Korean National Health Insurance Service database. Patients were categorised into three groups according to the estimated glomerular filtration rate (eGFR) and six groups according to dipstick proteinuria and were followed up until December 2018. The primary outcome was the development of IE, which was defined using ICD-10 codes (I33.x, I38.x, I39.8) combined with hospitalisation for >14 days or death within 14 days. The relative risk of IE was estimated using adjusted hazard ratios (aHRs).
In total, 866,918 patients were included, of whom 107,746 had an eGFR <60 mL/minute/1.73 m2. During the follow-up (median, 12.3 years), 821 cases of IE occurred. Patients with an eGFR <60 mL/minute/1.73 m2 had a higher risk of IE (aHR: 1.357, 95% confidence interval 1.098-1.676) than those with an eGFR ≥90 mL/minute/1.73 m2. The risk of IE increased as the severity of proteinuria increased, irrespective of the presence of CKD.
CKD and proteinuria in the population with diabetes are associated with an increased risk of developing IE. The association of proteinuria with the risk of IE may be more significant than that of impaired renal function. However, as this study relied on claim codes and single-time-point assessments of kidney parameters, potential misclassification and residual confounding-including lack of adjustment for healthcare-related exposures-should be considered.
慢性肾脏病（CKD）和/或蛋白尿与未接受替代治疗的CKD患者感染性心内膜炎（IE）风险之间的关联尚不清楚。本研究评估了CKD和/或蛋白尿对糖尿病患者发生IE风险的影响。
在这项基于全国人群的队列研究中，从韩国国民健康保险服务数据库中获取了2009年接受健康检查的糖尿病患者的数据。根据估计肾小球滤过率（eGFR）将患者分为三组，根据尿试纸蛋白尿分为六组，并随访至2018年12月。主要结局是IE的发生，其定义为使用国际疾病分类第十版（ICD-10）编码（I33.x、I38.x、I39.8）并结合住院超过14天或14天内死亡。使用调整后的风险比（aHRs）估计IE的相对风险。
总共纳入了866,918例患者，其中107,746例的eGFR<60 mL/分钟/1.73 m²。在随访期间（中位数为12.3年），发生了821例IE。eGFR<60 mL/分钟/1.73 m²的患者发生IE的风险（aHR：1.357，95%置信区间1.098-1.676）高于eGFR≥90 mL/分钟/1.73 m²的患者。无论是否存在CKD，IE的风险随着蛋白尿严重程度的增加而增加。
糖尿病人群中的CKD和蛋白尿与发生IE的风险增加相关。蛋白尿与IE风险的关联可能比肾功能受损更为显著。然而，由于本研究依赖于索赔编码和肾脏参数的单次评估，应考虑潜在的错误分类和残余混杂因素，包括未对医疗相关暴露进行调整。
