CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study

Junichi Ishigami, Morgan Grams, Alexander R. Chang, Juan J. Carrero, Josef Coresh, Kunihiro Matsushita

Research output: Contribution to journalArticle


Background: Individuals on dialysis therapy have a high risk for infection, but risk for infection in earlier stages of chronic kidney disease has not been comprehensively described. Study Design: Observational cohort study. Setting & Participants: 9,697 participants (aged 53-75 years) in the Atherosclerosis Risk in Communities (ARIC) Study. Participants were followed up from 1996 to 1998 through 2011. Predictors: Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR). Outcomes: Risk for hospitalization with infection and death during or within 30 days of hospitalization with infection. Results: During follow-up (median, 13.6 years), there were 2,701 incident hospitalizations with infection (incidence rate, 23.6/1,000 person-years) and 523 infection-related deaths. In multivariable analysis, HRs of incident hospitalization with infection as compared to eGFRs≥90mL/min/1.73m2 were 2.55 (95% CI, 1.43-4.55), 1.48 (95% CI, 1.28-1.71), and 1.07 (95% CI, 0.98-1.16) for eGFRs of 15 to 29, 30 to 59, and 60 to 89mL/min/1.73m2, respectively. Corresponding HRs were 3.76 (95% CI, 1.48-9.58), 1.62 (95% CI, 1.20-2.19), and 0.99 (95% CI, 0.80-1.21) for infection-related death. Compared to ACRs<10mg/g, HRs of incident hospitalization with infection were 2.30 (95% CI, 1.81-2.91), 1.56 (95% CI, 1.36-1.78), and 1.34 (95% CI, 1.20-1.50) for ACRs≥300, 30 to 299, and 10 to 29mg/g, respectively. Corresponding HRs were 3.44 (95% CI, 2.28-5.19), 1.57 (95% CI, 1.18-2.09), and 1.39 (95% CI, 1.09-1.78) for infection-related death. Results were consistent when separately assessing risk for pneumonia, kidney and urinary tract infections, bloodstream infections, and cellulitis and when taking into account recurrent episodes of infection. Limitations: Outcome ascertainment relied on diagnostic codes at time of discharge. Conclusions: Increasing provider awareness of chronic kidney disease as a risk factor for infection is needed to reduce infection-related morbidity and mortality.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
StateAccepted/In press - Jun 28 2016



  • Albuminuria
  • Bacteremia
  • Cellulitis
  • Chronic kidney disease (CKD)
  • Chronic kidney failure
  • Chronic renal insufficiency
  • Glomerular filtration rate (GFR)
  • Hospitalization
  • Infection
  • Infectious disease
  • Kidney function
  • Pneumonia
  • Proteinuria
  • Respiratory tract infections
  • Urinary tract infections

ASJC Scopus subject areas

  • Nephrology

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