The risk of infection-related hospitalization with decreased kidney function

Lorien Dalrymple, Ronit Katz, Bryan Kestenbaum, Ian H. De Boer, Linda Fried, Mark J. Sarnak, Michael G. Shlipak

Research output: Contribution to journalArticlepeer-review

76 Scopus citations


Background: Moderate kidney disease may predispose to infection. We sought to determine whether decreased kidney function, estimated by serum cystatin C level, was associated with the risk of infection-related hospitalization in older individuals. Study Design: Cohort study. Setting & Participants: 5,142 Cardiovascular Health Study (CHS) participants with measured serum creatinine and cystatin C and without estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m 2 at enrollment. Predictor: The primary exposure of interest was eGFR using serum cystatin C level (eGFR SCysC). Outcome: Infection-related hospitalizations during a median follow-up of 11.5 years. Results: In adjusted analyses, eGFR SCysC categories of 60-89, 45-59, and 15-44 mL/min/1.73 m 2 were associated with 16%, 37%, and 64% greater risk of all-cause infection-related hospitalization, respectively, compared with eGFR SCysC <90 mL/min/1.73 m 2. When cause-specific infection was examined, eGFR SCysC of 15-44 mL/min/1.73 m 2 was associated with an 80% greater risk of pulmonary and 160% greater risk of genitourinary infection compared with eGFR SCysC <90 mL/min/1.73 m 2. Limitations: No measures of urinary protein, study limited to principal discharge diagnosis. Conclusions: Lower kidney function, estimated using cystatin C level, was associated with a linear and graded risk of infection-related hospitalization. These findings highlight that even moderate degrees of decreased kidney function are associated with clinically significant higher risks of serious infection in older individuals.

Original languageEnglish (US)
Pages (from-to)356-363
Number of pages8
JournalAmerican Journal of Kidney Diseases
Issue number3
StatePublished - Mar 2012


  • chronic kidney disease
  • clinical epidemiology
  • infection
  • Renal disease

ASJC Scopus subject areas

  • Nephrology


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