Sepsis and the Risks of Long-Term Renal Adverse Outcomes in Patients With Chronic Kidney Disease

Shuo-Ming Ou; Kuo-Hua Lee; Ming-Tsun Tsai; Wei-Cheng Tseng; Yuan-Chia Chu; Der-Cherng Tarng

doi:10.3389/fmed.2022.809292

Sepsis and the Risks of Long-Term Renal Adverse Outcomes in Patients With Chronic Kidney Disease

Front Med (Lausanne). 2022 Feb 24:9:809292. doi: 10.3389/fmed.2022.809292. eCollection 2022.

Authors

Shuo-Ming Ou^{1

2

3

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6}, Kuo-Hua Lee^{1

2

3

4

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6}, Ming-Tsun Tsai^{1

2

3

4

5

6}, Wei-Cheng Tseng^{1

2

3

4

5

6}, Yuan-Chia Chu^{7

8

9}, Der-Cherng Tarng^{1

2

3

4

5

6

10

11}

Affiliations

¹ Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
² School of Medicine, National Yang-Ming University, Taipei, Taiwan.
³ School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁴ Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
⁵ Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
⁶ Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁷ Information Management Office, Taipei Veterans General Hospital, Taipei City, Taiwan.
⁸ Big Data Center, Taipei Veterans General Hospital, Taipei City, Taiwan.
⁹ Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
¹⁰ Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan.
¹¹ Department and Institute of Physiology, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Abstract

Background: Sepsis is known to cause renal function fluctuations during hospitalization, but whether these patients discharged from sepsis were still at greater risks of long-term renal adverse outcomes remains unknown.

Methods: From 2011 to 2018, we included 1,12,628 patients with chronic kidney disease (CKD) aged ≥ 20 years. The patients with CKD were further divided into 11,661 sepsis group and 1,00,967 non-sepsis group. The following outcome of interest was included: all-cause mortality, readmission for acute kidney injury, estimated glomerular filtration rate decline ≥50% or doubling of serum creatinine, and end-stage renal disease.

Results: After propensity score matching, the sepsis group was at higher risks of all-cause mortality [hazard ratio (HR) 1.39, 95% CI, 1.31-1.47], readmission for acute kidney injury (HR 1.67, 95% CI 1.58-1.76), eGFR decline ≥ 50% or doubling of serum creatinine (HR 3.34, 95% CI 2.78-4.01), and end-stage renal disease (HR 1.43, 95% CI 1.34-1.53) than non-sepsis group.

Conclusions: Our study found that patients with CKD discharged from hospitalization for sepsis have higher risks of subsequent renal adverse events.

Keywords: AKI (acute kidney injury); chronic kidney disease; end-stage renal disease; renal function decline; sepsis.