Epidemiological Patterns of Infection in Chronic Kidney Disease

Chronic kidney disease (CKD) is increasingly recognised as a condition that compromises immune competence, leading to elevated susceptibility to a spectrum of infections. Epidemiological studies reveal that as renal function declines, rates of infection-related hospitalisation and sepsis rise, contributing substantially to morbidity and mortality. Common infectious presentations include urinary tract infections, respiratory tract infections, skin and soft-tissue infections, and bloodstream infections progressing to sepsis. Risk factors such as older age, diabetes, proteinuria and comorbid cardiovascular disease interact with reduced estimated glomerular filtration rate (eGFR) to amplify risk. Moreover, infection episodes accelerate CKD progression and heighten post-dialysis adverse outcomes, while interventions such as red blood cell transfusion in septic CKD patients or early management of sterile pyuria may modify prognosis. Globally, this interplay imposes a heavy burden on health systems, underscoring the need for tailored prevention strategies, vigilant surveillance and targeted therapeutic approaches to mitigate infection-driven CKD progression and improve patient survival.

Research from Nature Portfolio

Recent studies have examined whether specific interventions and pre-existing infection exposure alter outcomes in CKD cohorts. A 2024 intensive care analysis found that in patients with sepsis and CKD, judicious red blood cell transfusion was associated with a 40 % reduction in 28-day mortality. Key parameters such as Sequential Organ Failure Assessment (SOFA) score, base excess and eGFR thresholds informed transfusion decisions, suggesting that personalised thresholds can improve survival.

A large nationwide cohort study assessed the long-term impact of infections occurring before end-stage renal disease. Patients who experienced any serious infection during advanced CKD had a 30–35 % higher risk of all-cause mortality in the first year after initiating dialysis, with incremental increases in adverse cardiovascular and infection-related hospitalisations corresponding to the annual number of infections.

Investigations into pyuria in CKD stages 3–5 have shown that two or more episodes of sterile pyuria or documented urinary tract infection within a year were linked to a near doubling of the risk of progression to end-stage renal disease and a 60 % higher risk of all-cause death. These findings highlight the dual role of urinary inflammation and infection in accelerating renal deterioration.

Epidemiological Patterns of Infection in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in epidemiological patterns of infection in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Estimated glomerular filtration rate (eGFR): A calculated index of kidney function based on serum creatinine, age, sex and race.

Sepsis: Life-threatening organ dysfunction caused by a dysregulated host response to infection.

Hazard ratio (HR): A measure of effect comparing the hazard rates of two groups over time.

Propensity score matching (PSM): A statistical method to balance covariates between treated and control groups in observational studies.

Pyuria: The presence of white blood cells in the urine, indicating inflammation or infection.

End-stage renal disease (ESRD): The final stage of CKD requiring dialysis or transplantation for survival.

References

1. Chronic Kidney Disease and Infection Risk: A Lower Incidence of Peritonsillar Abscesses in Specific CKD Subgroups in a 16-Year Korean Nationwide Cohort Study. Microorganisms (2024).
2. Association between red blood cells transfusion and 28-day mortality rate in septic patients with concomitant chronic kidney disease. Scientific Reports (2024).
3. Infection in Advanced Chronic Kidney Disease and Subsequent Adverse Outcomes after Dialysis Initiation: A Nationwide Cohort Study. Scientific Reports (2020).
4. Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3–5. Scientific Reports (2020).
5. Stratified risks of infection-related hospitalization in patients with chronic kidney disease - A prospective cohort study. Scientific Reports (2020).
6. Sepsis and the Risks of Long-Term Renal Adverse Outcomes in Patients With Chronic Kidney Disease. Frontiers in Medicine (2022).
7. The Impact of Infections on the Progression of Chronic Kidney Disease. Medicina (2023).