Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: A nationwide population-based study
Journal
Nephrology Dialysis Transplantation
Journal Volume
32
Journal Issue
10
Pages
1683-1690
Date Issued
2017
Author(s)
Abstract
Background Infections are a major cause of morbidity in patients with systemic lupus erythematosus (SLE), and may lead to death. No nationally representative study of patients with SLE has examined the rates of infection-related hospitalization and the risk of end-stage renal disease (ESRD). Methods We conducted a nationwide cohort study of 7326 patients with newly diagnosed SLE and no history of ESRD. All data were from Taiwan's National Health Insurance claims database for the period 2000-11. Results Among all SLE patients, 316 (4.3%) developed ESRD (mean follow-up time: 8.1 years). Multivariate Cox regression analysis indicated that the risk of ESRD increased with the number of infection-related hospitalizations. For patients with three or more infection-related admissions, the hazard ratio (HR) for ESRD was 5.08 [95% confidence interval (CI): 3.74-6.90] relative to those with no infection-related admission. Analysis by type of infection indicated that bacteremia patients had the greatest risk for ESRD (HR: 4.82; 95% CI: 3.40-6.85). Analysis of age of SLE onset indicated that patients with juvenile-onset (<18 years) and three or more infection-related hospitalizations had a greatly increased risk for ESRD (HR: 14.49; 95% CI: 5.34-39.33). Conclusions Infection-related hospitalizations are associated with a significantly increased risk of ESRD in patients with SLE, especially those with juvenile-onset SLE. Among patients with different types of infectious diseases, those with bacteremia were more likely to develop ESRD. ? The Authors 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Subjects
end-stage renal disease; hospitalization; infection; National Health Insurance; systemic lupus erythematosus
SDGs
Other Subjects
azathioprine; calcineurin inhibitor; cyclophosphamide; hydroxychloroquine; methotrexate; mycophenolic acid; prednisolone; adult; Article; bacteremia; cellulitis; cohort analysis; controlled study; end stage renal disease; female; high risk patient; hospital admission; hospitalization; human; incidence; infection; major clinical study; male; onset age; pneumonia; population research; priority journal; risk factor; septicemia; sex difference; soft tissue infection; systemic lupus erythematosus; Taiwan; urinary tract infection; urogenital tract infection; adolescent; bacterial infection; chronic kidney failure; complication; hospitalization; middle aged; mortality; multivariate analysis; proportional hazards model; systemic lupus erythematosus; young adult; Adolescent; Adult; Age of Onset; Bacterial Infections; Cohort Studies; Female; Hospitalization; Humans; Incidence; Kidney Failure, Chronic; Lupus Erythematosus, Systemic; Male; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Risk Factors; Young Adult
Publisher
Oxford University Press
Type
journal article