Kidney Week

Abstract: SA-PO786

Infection-Related Hospitalizations Across Different Levels of Kidney Function: Data from the EXTEND45 Study

Session Information

• CKD: Epidemiology, Risk Factors, Prevention - III
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Neuen, Brendon Lange, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Brendon Lange Neuen,

• Jardine, Meg J., The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Meg J. Jardine,

• Sukkar, Louisa, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Louisa Sukkar,

• Kang, Amy, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Amy Kang,

• Foote, Celine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia

Celine Foote,

• Rogers, Kris, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Kris Rogers,

• Scaria, Anish, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Anish Scaria,

• Cass, Alan, Menzies School of Health Research, Darwin, Northern Territory, Australia

Alan Cass,

• Gallagher, Martin P., The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Martin P. Gallagher,

• Jun, Min, The George Institute for Global Health, UNSW Sydney, Newtown, New South Wales, Australia

Min Jun,

Group or Team Name

• EXTEND45 Study Steering Committee

Background

The risk of infection associated with differing levels of kidney function is unclear. We sought to determine the risk of infection-related hospitalization and mean hospital length of stay across different levels of kidney function in a community-based cohort study.

Methods

Based on data from the EXTEND45 Study (the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record Linkage [CHeReL]), we identified a population-based cohort (2006-2014) of 41,099 people aged ≥45 years who had a measure of kidney function (estimated glomerular filtration rate [eGFR]). The risk of infection-related hospitalization and mean hospital length of stay were assessed by eGFR categories (≥90, 60-89, 45-59, 30-44 and <30ml/min/1.73m²) using multivariable Cox regression.

Results

Of 41,099 participants, 18.6% had an eGFR <60 ml/min/1.73m². Overall, 2,598 (6.3%) participants experienced ≥1 infection-related hospitalization over a mean follow-up of 5.8 years. After adjusting for age and sex, risk of infection increased with declining eGFR in a graded and linear fashion (HR 0.91 [95% CI: 0.79-1.04], 1.16 [0.99-1.37], 1.48 [1.22-1.78], and 1.83 [1.44-2.31] for eGFR ≥90, 60-89, 45-59, 30-44, and <30 ml/min/1.73 respectively). Pneumonia, urinary tract infections, and cellulitis were the most common infections across all eGFR categories. Mean hospital length of stay similarly increased with declining eGFR categories (4.9, 6.5, 7.5, 7.8 and 7.9 days, respectively).

Conclusion

The risk of serious infection increases as kidney function declines, independent of age and sex, suggesting that susceptibility is likely related to other factors (e.g. alterations in immune function) and begins in mild-moderate renal impairment.

Funding

• Commercial Support – The EXTEND45 Study is funded through peer-reviewed (NSW Cardiovascular Research Network Collaborative Project Grant) and unrestricted industry (from MSD, Amgen and Eli Lilly) research grants.