Non-Dialysis CKD Patients Have Increased Sepsis Risk

Associations between eGFR, bloodstream infection, and death within 30 days of community-onset bloodstream infection, after adjustment for potential confounders, were estimated with Cox proportional hazards models with censoring at the initiation of renal replacement therapy or death.

At least one bloodstream infection developed in 797 of 25,675 patients who were followed up for a median of 3.2 years. Most of these infections (75 percent) were community onset. Compared with patients with an eGFR of 60 mL/minute/1.73 m2 or higher, adjusted hazard ratios (HRs) for bloodstream infection were 1.24 (95 percent confidence interval [CI], 1.01-1.52) in those with an eGFR of 45 to 59 mL/minute/1.73 m2, 1.59 (95 percent CI, 1.24-2.04) in those with an eGFR of 30 to 44 mL/minute/1.73 m2, and 3.54 (95 percent CI, 2.69-4.69) in those with an eGFR of less than 30 mL/minute/1.73 m2.

These associations were similar for both community-onset and nosocomial infections. The risk for death within 30 days of community-onset bloodstream infection was significantly greater in patients with an eGFR of less than 30 mL/minute/1.73 m2 versus patients with an eGFR of 60 mL/minute/1.73m2 or more (HR, 4.10; 95% CI, 2.06-8.14).

"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," the study authors wrote. "Further research is needed to characterize sources of infection and the potential for additional morbidity from infections that are not manifested by bacteremia."