Abstract
It remains unclear whether infection events before entering end stage renal disease (ESRD) have a long-term negative impact on patients with advanced chronic kidney disease (CKD) who survive to permanent dialysis. We enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis between January 1, 2004 and December 31, 2013. We used multivariable Cox as well as Fine and Gray models to determine the association of pre-dialysis infection exposure with all-cause mortality after starting dialysis. Compared with no infection during advanced CKD, the presence of infection exposure during that period was independently associated with a higher risk of all-cause mortality in the first year of dialysis (hazard ratio [HR] 1.34, 95% confidence interval [CI] 1.27–1.42) and also during the entire follow-up period (HR 1.19, 95% CI 1.16–1.22). The increased risks of all-cause mortality increased incrementally with higher annual number of infections during advanced CKD. Similar results were found for all other adverse outcomes, e.g. post-ESRD infection-related hospitalization and major cardiac and cerebrovascular events. In conclusion, infection events during advanced CKD was associated with increased risks of adverse outcomes after dialysis has been started. Timely interventions in such a vulnerable group may help attenuate these risks.
Highlights
Few studies have addressed the consequences of an infection event in non-dialysis patients with advanced chronic kidney disease (CKD)
Www.nature.com/scientificreports end-stage renal disease (ESRD) or other adverse outcome before dialysis, such as cardiovascular events and death[15]. It remains unclear whether infection events before entering ESRD have a long-term negative impact on patients with advanced CKD who survive to permanent dialysis
To address this knowledge gap, we investigated the association of infection exposure during advanced CKD and adverse outcomes, e.g. all-cause mortality, recurrent IRH, major cardiac and cerebrovascular events (MACCE), after dialysis initiation by using a nationwide representative population with advanced CKD transitioning to ESRD
Summary
Few studies have addressed the consequences of an infection event in non-dialysis patients with advanced CKD. A recent analysis of the Canadian prospective cohort (CanPREDDICT) comprising 2,370 patients with advanced CKD showed that an infection episode was independently associated with an increased risk of end-stage renal disease (ESRD) or other adverse outcome before dialysis, such as cardiovascular events and death[15]. It remains unclear whether infection events before entering ESRD have a long-term negative impact on patients with advanced CKD who survive to permanent dialysis. We hypothesized that infection exposure in advanced CKD might lead to a higher risk of adverse outcomes before ESRD and have a persistently negative impact after transitioning to permanent dialysis
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