Impact of urinary tract infection requiring hospital admission on short-term, mid-term and long-term renal outcomes in adult CKD patients – A potentially modifiable factor for CKD progression

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-02-20 DOI:10.1016/j.jiph.2025.102712

Deng-Chi Yang , Jo-Yen Chao , Chih-Yen Hsiao , Chien-Tzu Tseng , Wei-Hung Lin , Te-Hui Kuo , Ming-Cheng Wang

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Abstract

Background

Urinary tract infection (UTI) or acute pyelonephritis can lead to renal scarring and impact the subsequent renal function progression. The aims of this study were to investigate the changes in renal function related to UTI requiring hospital admission (UTI/HA) and the association between UTI/HA and long-term renal outcomes in patients with chronic kidney disease (CKD).

Methods

This was a multicenter, retrospective observational study. Renal events and renal function before and after UTI/HA in CKD patients were analyzed for short-term and mid-term renal outcomes. A case-control study with multivariate logistic regression analysis was used to investigate the association between clinical characteristics and risk of long-term renal outcomes (kidney replacement therapy or death, KRT/death) in adult CKD patients.

Results

This study included 1062 adult CKD patients, with 340 KRT and 76 deaths identified during a median follow-up of 105 months. Among 174 patients with UTI/HA, 59 (33.9 %) had bacteremia, 90 (51.7 %) acute kidney injury (AKI), and one in-hospital mortality. There was a faster decline rate of estimated glomerular filtration rate (eGFR) after UTI/HA compared to the pre-UTI/HA period [median (IQR) 0.37 (0.17–0.72) versus 0.19 (0.06–0.36) ml/min/1.73 m² per month, P < 0.0001]. The incidence of UTI/HA was similar between the KRT/death and the CKD non-dialysis groups. Multivariate logistic regression analysis showed that baseline eGFR, baseline eGFR decline rate and number of hospital admission were significantly associated with an increased risk of KRT/death.

Conclusions

This study highlights the impact of UTI/HA on renal function and renal outcomes in adult CKD patients. It demonstrates a high incidence of in-hospital AKI but low mortality, and accelerated deterioration of renal function following UTI/HA. Long-term renal outcomes were influenced by the baseline renal function and progression rate, and the frequency of hospital admission. UTI/HA may be regarded as a potentially modifiable factor for CKD progression. However, there is a need for further analysis to isolate the impact of UTI/HA from pre-existing renal function decline on long-term renal outcomes.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.