Stratified risks of infection-related hospitalization in patients with chronic kidney disease - A prospective cohort study

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Abstract

Patients with chronic kidney disease (CKD) are at high risk of infection, but whether the risks are attenuated in different patient groups remains unclear. This study enrolled participants with CKD stages 1–3 in the New Taipei City Health Screening Program between 2005 and 2008. A proportional hazard regression model was employed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for infection-related hospitalization and mortality in younger (<50-year-old) and older (≥50-year-old) CKD patients. Of 119,871 adults, there were 14,207 cases of first hospitalization for infection during a median follow-up of 8.14 years; 45.5% of these cases were younger patients. Unlike CKD stage 1 and 2 patients, the risk of infection-related hospitalization in younger CKD stage 3 patients is as high as for older CKD stage 3 patients. Proteinuria increases the risk of infection-related hospitalization independent of estimated glomerular filtration rate (eGFR) levels in older CKD patients but this relationship is weak in their younger counterparts. In conclusion, the risk of infection-related hospitalization is high in subgroups of CKD patients. Prevention and treatment of infections in these patients merit more attention.

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Factors affecting therapeutic compliance: A review from the patient’s perspective

Jing Jin, Grant Sklar, Vernon Min Sen Oh … (2008)

Objective To explore and evaluate the most common factors causing therapeutic non-compliance. Methods A qualitative review was undertaken by a literature search of the Medline database from 1970 to 2005 to identify studies evaluating the factors contributing to therapeutic non-compliance. Results A total of 102 articles was retrieved and used in the review from the 2095 articles identified by the literature review process. From the literature review, it would appear that the definition of therapeutic compliance is adequately resolved. The preliminary evaluation revealed a number of factors that contributed to therapeutic non-compliance. These factors could be categorized to patient-centered factors, therapy-related factors, social and economic factors, healthcare system factors, and disease factors. For some of these factors, the impact on compliance was not unequivocal, but for other factors, the impact was inconsistent and contradictory. Conclusion There are numerous studies on therapeutic noncompliance over the years. The factors related to compliance may be better categorized as “soft” and “hard” factors as the approach in countering their effects may differ. The review also highlights that the interaction of the various factors has not been studied systematically. Future studies need to address this interaction issue, as this may be crucial to reducing the level of non-compliance in general, and to enhancing the possibility of achieving the desired healthcare outcomes.

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Nationwide Population Science: Lessons From the Taiwan National Health Insurance Research Database.

Ann W Hsing, John Ioannidis (2015)

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Epidemiology of acute infections among patients with chronic kidney disease.

A Go, Lorien Dalrymple (2008)

The objectives of this review were (1) to review recent literature on the rates, risk factors, and outcomes of infections in patients who had chronic kidney disease (CKD) and did or did not require renal replacement therapy; (2) to review literature on the efficacy and use of selected vaccines for patients with CKD; and (3) to outline a research framework for examining key issues regarding infections in patients with CKD. Infection-related hospitalizations contribute substantially to excess morbidity and mortality in patients with ESRD, and infection is the second leading cause of death in this population. Patients who have CKD and do not require renal replacement therapy seem to be at higher risk for infection compared with patients without CKD; however, data about patients who have CKD and do not require dialysis therapy are very limited. Numerous factors potentially predispose patients with CKD to infection: advanced age, presence of coexisting illnesses, vaccine hyporesponsiveness, immunosuppressive therapy, uremia, dialysis access, and the dialysis procedure. Targeted vaccination seems to have variable efficacy in the setting of CKD and is generally underused in this population. In conclusion, infection is a primary issue when caring for patients who receive maintenance dialysis. Very limited data exist about the rates, risk factors, and outcomes of infection in patients who have CKD and do not require dialysis. Future research is needed to delineate accurately the epidemiology of infections in these populations and to develop effective preventive strategies across the spectrum of CKD severity.

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Author and article information

Contributors

Jiun-Ling Wang:

ORCID: http://orcid.org/0000-0002-9465-8692

jiunlingwang@gmail.com

Journal

Journal ID (nlm-ta): Sci Rep

Journal ID (iso-abbrev): Sci Rep

Title: Scientific Reports

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2045-2322

Publication date (Electronic): 11 March 2020

Publication date PMC-release: 11 March 2020

Publication date Collection: 2020

Volume: 10

Electronic Location Identifier: 4475

Affiliations

[1 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, National Taiwan University Hospital, Hsin-Chu Branch, Department of Internal Medicine, ; Hsin-Chu City, Taiwan

[2 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, National Taiwan University, College of Medicine, ; Taipei, Taiwan

[3 ]ISNI 0000 0004 0546 0241, GRID grid.19188.39, National Taiwan University, The Graduate Institute of Medical Genomics and Proteomics, ; Taipei, Taiwan

[4 ]ISNI 0000 0004 0572 7815, GRID grid.412094.a, National Taiwan University Hospital, Department of Internal Medicine, ; Taipei, Taiwan

[5 ]ISNI 0000 0001 2287 1366, GRID grid.28665.3f, Academia Sinica, Institute of Biomedical Sciences, ; Taipei, Taiwan

[6 ]ISNI 0000 0004 0639 0054, GRID grid.412040.3, Department of Internal Medicine, , National Cheng Kung University Hospital, ; Tainan, Taiwan

[7 ]ISNI 0000 0004 0532 3255, GRID grid.64523.36, College of Medicine, , National Cheng Kung University, ; Tainan, Taiwan

Author information

Jiun-Ling Wang http://orcid.org/0000-0002-9465-8692

Article

Publisher ID: 61144

DOI: 10.1038/s41598-020-61144-6

PMC ID: 7066158

PubMed ID: 32161271

SO-VID: ed34dd15-1849-4e5d-aa1b-68427447029a

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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 13 November 2019

Date accepted : 17 February 2020

Funding

Funded by: FundRef https://doi.org/10.13039/501100004663, Ministry of Science and Technology, Taiwan (Ministry of Science and Technology of Taiwan);

Award ID: MOST 107-2314-B-002-194

Award Recipient : Chia-Hsuin Chang

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ScienceOpen disciplines: Uncategorized

Keywords: bacterial infection,chronic kidney disease,epidemiology

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ScienceOpen disciplines: Uncategorized

Keywords: bacterial infection, chronic kidney disease, epidemiology

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Stratified risks of infection-related hospitalization in patients with chronic kidney disease - A prospective cohort study

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Decoding Infection and Transmission

Most cited references 28

Factors affecting therapeutic compliance: A review from the patient’s perspective

Nationwide Population Science: Lessons From the Taiwan National Health Insurance Research Database.

Epidemiology of acute infections among patients with chronic kidney disease.

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Cited by 5

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