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Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study.

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.

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  • Authors+Show Affiliations

    ,

    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.

    Source

    MeSH

    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

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    28011646

    Citation

    Lin, Chien-Hung, et al. "Infection-related Hospitalization and Risk of End-stage Renal Disease in Patients With Systemic Lupus Erythematosus: a Nationwide Population-based Study." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 32, no. 10, 2017, pp. 1683-1690.
    Lin CH, Hung PH, Hu HY, et al. Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study. Nephrol Dial Transplant. 2017;32(10):1683-1690.
    Lin, C. H., Hung, P. H., Hu, H. Y., Chen, Y. J., Guo, H. R., & Hung, K. Y. (2017). Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 32(10), pp. 1683-1690. doi:10.1093/ndt/gfw407.
    Lin CH, et al. Infection-related Hospitalization and Risk of End-stage Renal Disease in Patients With Systemic Lupus Erythematosus: a Nationwide Population-based Study. Nephrol Dial Transplant. 2017 Oct 1;32(10):1683-1690. PubMed PMID: 28011646.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Infection-related hospitalization and risk of end-stage renal disease in patients with systemic lupus erythematosus: a nationwide population-based study. AU - Lin,Chien-Hung, AU - Hung,Peir-Haur, AU - Hu,Hsiao-Yun, AU - Chen,Yann-Jang, AU - Guo,How-Ran, AU - Hung,Kuan-Yu, PY - 2016/06/28/received PY - 2016/09/29/accepted PY - 2016/12/25/pubmed PY - 2018/3/1/medline PY - 2016/12/25/entrez KW - National Health Insurance KW - end-stage renal disease KW - hospitalization KW - infection KW - systemic lupus erythematosus SP - 1683 EP - 1690 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol. Dial. Transplant. VL - 32 IS - 10 N2 - 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. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/28011646/Infection_related_hospitalization_and_risk_of_end_stage_renal_disease_in_patients_with_systemic_lupus_erythematosus:_a_nationwide_population_based_study_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfw407 DB - PRIME DP - Unbound Medicine ER -