This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Bacterial Infections  • Renal Diseases, Other  • Hematology, Other  • Alert me on articles by topic

Matthew T. James, MD; Kevin B. Laupland, MD, MSc; Marcello Tonelli, MD, SM; Braden J. Manns, MD, MSc; Bruce F. Culleton, MD, MS; Brenda R. Hemmelgarn, PhD, MD; for the Alberta Kidney Disease Network

Arch Intern Med. 2008;168(21):2333-2339.

Background  Patients with end-stage renal disease requiring dialysis are at high risk for bloodstream infection and infection-related death. Whether patients with chronic kidney disease who are not receiving dialysis are also at increased risk of bloodstream infection is less clear.

Methods  We examined the association between chronic kidney disease not being treated with dialysis and bloodstream infection in a cohort of patients 66 years or older. All patients required at least 1 outpatient serum creatinine measurement enabling estimation of glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease Study equation. Cox proportional hazards models with censoring at the initiation of renal replacement therapy or death were used to determine associations between eGFR, bloodstream infection, and death within 30 days of community-onset bloodstream infection, adjusting for potential confounders.

Results  In 25 675 patients followed up for a median of 3.2 years, 797 developed at least 1 bloodstream infection, of which most (75%) were community-onset infections. Compared with patients with an eGFR of 60 mL/min/1.73 m² or higher, adjusted hazard ratios (95% confidence intervals) for bloodstream infection according to eGFR were, respectively, 1.24 (1.01-1.52), 1.59 (1.24-2.04), and 3.54 (2.69-4.69) in those with an eGFR of 45 to 59, 30 to 44, and less than 30 mL/min/1.73 m². The associations were consistent for both community-onset and nosocomial infections. Compared with patients with an eGFR of 60 mL/min/1.73 m² or higher, the risk of death within 30 days of community-onset bloodstream infection was significantly greater in those with an eGFR less than 30 mL/min/1.73 m² (hazard ratio, 4.10; 95% confidence interval, 2.06-8.14).

Conclusion  Older adults with chronic kidney disease not being treated with dialysis are at increased risk of bloodstream infection and of death following community-onset bloodstream infection.

Author Affiliations: Departments of Medicine (Drs James, Laupland, Manns, Culleton, and Hemmelgarn) and Community Health Sciences (Drs James, Laupland, Manns, and Hemmelgarn), University of Calgary, and Division of Nephrology, Foothills Medical Centre (Dr Hemmelgarn), Calgary, Alberta, Canada; Department of Medicine, University of Alberta (Dr Tonelli), and Institute of Health Economics (Drs Tonelli and Manns), Edmonton, Alberta, Canada; and Baxter Healthcare, Deerfield, Illinois (Dr Culleton).
Group Information: A list of the Alberta Kidney Disease Network appears at http://www.akdn.info/contact.html.