Estimated glomerular filtration rate, albuminuria, and risk of infection: a collaborative meta-analysis of individual participant data
Abstract
Summary Background Infections are a major cause of hospitalization in people with chronic kidney disease (CKD), with incidence similar to cardiovascular disease, yet the risk of infection has not been systematically studied across stages of CKD. Methods We conducted a meta-analysis of individual participant data including 1,246,912 individuals across 47 cohorts in the CKD Prognosis Consortium, with information on estimated glomerular filtration rate based on serum creatinine (eGFRcr) and urinary albuminuria (ACR) (or proteinuria converted to ACR), to examine the association of eGFR and ACR with the risk of hospitalization with infection. Outcomes were ascertained through diagnostic codes on hospital discharge records relevant to acute infections (i.e., upper and lower respiratory tract, urinary tract, skin and soft tissue, musculoskeletal, gastrointestinal tract, genital, nervous system, and cardiovascular system infections, and sepsis). Follow-up was censored on December 31, 2019 or on the last date of cohort follow-up, whichever was earlier. Multivariable Cox models were used to estimate hazard ratios (HRs). Findings During follow-up, 170,864 (13.7%) individuals had a hospitalization with infection (IR, 22.0 [IQI, 16.2–31.0] per 1000 person-yrs). In Cox models, compared to eGFRcr 90–104 ml/min/1.73 m2 and ACR <10 mg/g, lower eGFRcr and higher ACR were each independently associated with an increased hazard of infection in a graded manner, including in eGFRcr 60–89 and 45–59…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,246,912 participants or records.
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