According to researchers, a patient’s risk for hospitalization and death increases as chronic kidney disease (CKD) advances. It’s been unclear, however, if illnesses caused by an infection may hurt CKD patients prior to entering end-stage kidney disease (ESKD), where permanent dialysis may be warranted. Learn what researchers discovered about how prior exposure to infections can affect advanced CKD patients who are starting dialysis.* 

What they did

Between 2004 and 2013, researchers enrolled 62,872 patients with advanced CKD who transitioned to maintenance dialysis. Using various analytical tools, they compared the health outcomes of patients with no infections to those of patients with an active infection.

What they found

The research team discovered that:

• Nearly one-third of the patients experienced at least one infection event before transitioning to permanent dialysis, and
• Infections prior to starting dialysis were associated with negative health outcomes during dialysis. 

These negative outcomes included:

• Higher risk of death,
• Increased infection-related hospitalizations (IRH), and 
• Increased risk of major cardiac and cerebrovascular events, such as heart attack and stroke.

Pre-ESKD infection exposure increased the risk of post-ESKD IRH, especially among older patients and those receiving hemodialysis, and the risk of death increased in step with greater numbers of infections. All of the risks were highest during the first year of dialysis, yet remained significant after the first year. 

What it means

The connection between pre-ESKD infection and poor post-ESKD outcomes is “likely to be multifactorial,” the study authors write. The infection(s) may trigger chronic inflammation leading to worse outcomes, for instance, or treatment of the infection may be insufficient or delayed. The authors note that “a higher number of nephrologist visits during advanced CKD was associated with a lower risk” of post-ESKD IRH.  

Overall, they say, these findings stress the importance of preventative care in non-dialysis advanced CKD patients. Preventing infection exposure can help reduce the likelihood of other illnesses arising during maintenance dialysis, improving patients’ quality of life and lowering the burden on the healthcare system. 

*Chang, C. H., Fan, P. C., Kuo, G., Lin, Y. S., Tsai, T. Y., Chang, S. W., Tian, Y. C., & Lee, C. C. (2020). Infection in Advanced Chronic Kidney Disease and Subsequent Adverse Outcomes after Dialysis Initiation: A Nationwide Cohort Study. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-59794-7