Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study.
BackgroundInfections 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).
MethodsWe 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.
ResultsAmong 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).
ConclusionsInfection-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.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. Department of Pediatrics, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan.,
Department of Internal Medicine, Ditmanson Medical Foundation Chia-yi Christian Hospital, Chia-yi, Taiwan. Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan.,
Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
Age of Onset
Kidney Failure, Chronic
Lupus Erythematosus, Systemic
Proportional Hazards Models
Pub Type(s)Journal Article