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Hospital admission with pneumonia and subsequent persistent risk of chronic kidney disease: national cohort study
(Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-3649-2639
Örebro University, School of Medical Sciences. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0001-6328-5494
2018 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 971-979Article in journal (Refereed) Published
Abstract [en]

Background: Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD).

Patients and methods: Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into <= 5, > 5-<= 15, and > 15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31, 2009, whichever occurred first.

Results: During a median follow-up of 36.7 (interquartile range 35.3-37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41-20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91-6.93) and then attenuated with increasing time.

Conclusion: Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions.

Place, publisher, year, edition, pages
DOVE Medical Press Ltd. , 2018. Vol. 10, p. 971-979
Keywords [en]
pneumonia, kidney disease, end-stage renal disease, inflammation, cohort study
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-68653DOI: 10.2147/CLEP.S169039ISI: 000441779100001PubMedID: 30147376Scopus ID: 2-s2.0-85057756705OAI: oai:DiVA.org:oru-68653DiVA, id: diva2:1243540
Note

Funding Agency:

UK Economic and Social Research Council  RES-596-28-0001  ES/JO19119/1

Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2019-08-13Bibliographically approved
In thesis
1. A life-course approach to chronic kidney disease: risks and consequences
Open this publication in new window or tab >>A life-course approach to chronic kidney disease: risks and consequences
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Successful primary prevention of chronic kidney disease (CKD) relies on understanding the pathways leading to established disease, including how they extend over the life-course. Projects in this thesis examine risk factors for CKD and consequences of impaired kidney function from a life-course perspective using routinely collected health-data in Swedish registers and research cohort data from the United Kingdom.

The main findings regarding risk factors for CKD are, that markers of health and development determined at conscription assessment in adolescence, independently predict diagnosis of end-stage renal disease in middle age. We also identified a persistent increased risk of CKD following hospital admission with pneumonia in adulthood with highest magnitude risks in years immediately following infection, but still statistically significantly raised more than 15 years after the pneumonia episode. Our main findings relevant to predicting the consequences of impaired kidney function are that creatinine and cystatin C used clinically to estimate kidney function (estimated glomerular filtration rate, eGFR) have associations with increased mortality risk independent of GFR measured with an exogenous filtration marker (mGFR). If cystatin C and creatinine are combined, adding mGFR does not improve mortality risk prediction. Another important finding is that moderately reduced eGFR is only associated with a statistically significant increased mortality risk among individuals in the lowest third of the distribution of grip strength in a general population sample followed for 4-5 years, after adjustment for potential confounding factors.

These results highlight the importance of adopting a life-course perspective when studying risk factors for CKD, since these associations can extend over different stages in the life-course. When assessing increased mortality risk associated with measures of GFR, combining cystatin and creatinine improves risk prediction. Potential effect modification across subgroups, including by grip strength, should be considered.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 89
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 196
Keywords
chronic kidney disease, pneumonia, grip strength, creatinine, cystatin C, adolescence, life-course epidemiology, risk factor, mortality
National Category
General Practice Urology and Nephrology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-74659 (URN)978-91-7529-290-8 (ISBN)
Public defence
2019-09-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-08-13Bibliographically approved

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Sundin, Per-OlaUdumyan, RuzanFall, KatjaMontgomery, Scott

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