Chronic kidney disease and risk of bloodstream infections and sepsis: a 17-year follow-up of the population-based Trøndelag Health Study in Norway

Kristin Vardheim Liyanarachi; Randi Marie Mohus; Tormod Rogne; Lise Tuset Gustad; Bjørn Olav Åsvold; Solfrid Romundstad; Erik Solligård; Stein Hallan; Jan Kristian Damås

doi:10.1007/s15010-024-02265-2

Chronic kidney disease and risk of bloodstream infections and sepsis: a 17-year follow-up of the population-based Trøndelag Health Study in Norway

Infection. 2024 Apr 29. doi: 10.1007/s15010-024-02265-2. Online ahead of print.

Authors

Kristin Vardheim Liyanarachi^{1

2}, Randi Marie Mohus^#^{3

4}, Tormod Rogne^#^{3

5}, Lise Tuset Gustad^{3

6

7}, Bjørn Olav Åsvold^{8

9

10}, Solfrid Romundstad^{7

11}, Erik Solligård^{3

12}, Stein Hallan^{11

13}, Jan Kristian Damås^{3

14

15}

Affiliations

¹ Mid-Norway Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway. kristin.v.liyanarachi@ntnu.no.
² Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. kristin.v.liyanarachi@ntnu.no.
³ Mid-Norway Center for Sepsis Research, Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁴ Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁵ Yale Department of Chronic Disease Epidemiology and Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA.
⁶ Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.
⁷ Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
⁸ K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
⁹ Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹⁰ Department of Public Health and Nursing, HUNT Research Center, NTNU, Norwegian University of Science and Technology, Levanger, Norway.
¹¹ Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
¹² Helse Møre Og Romsdal Hospital Trust, Ålesund, Norway.
¹³ Department of Nephrology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹⁴ Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
¹⁵ Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.

^# Contributed equally.

PMID: 38679665
DOI: 10.1007/s15010-024-02265-2

Abstract

Purpose: Bloodstream infections (BSI) and sepsis are important causes of hospitalization, loss of health, and death globally. Targetable risk factors need to be identified to improve prevention and treatment. In this study, we aimed to evaluate the association of chronic kidney disease (CKD) and risk of and mortality from BSI and sepsis in the general population during a 22-year period.

Methods: We conducted a prospective cohort study among participants in the population-based Norwegian HUNT Study, where 68,438 participated. The median follow-up time was 17.4 years. The exposures were estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in urine. The outcomes were hazard ratios (HR) of hospital admission or death due to BSI or sepsis. The associations were adjusted for age, sex, diabetes, obesity, systolic blood pressure, smoking status, and cardiovascular disease.

Results: Participants with eGFR < 30 ml/min/1.73² had HR 3.35 for BSI (95% confidence intervals (CI) 2.12-5.3) and HR 2.94 for sepsis (95% CI 1.82-4.8) compared to normal eGFR (≥ 90 ml/min/1.73²). HRs of death from BSI and sepsis were 4.2 (95% CI 1.71-10.4) and 4.1 (95% CI 1.88-8.9), respectively. Participants with severely increased albuminuria (ACR > 30 mg/mmol) had HR 3.60 for BSI (95% CI 2.30-5.6) and 3.14 for sepsis (95% CI 1.94-5.1) compared to normal albumin excretion (ACR < 3 mg/mmol). HRs of death were 2.67 (95% CI 0.82-8.7) and 2.16 (95% CI 0.78-6.0), respectively.

Conclusion: In this large population-based cohort study, CKD was clearly associated with an increased risk of BSI and sepsis and related death.

Keywords: Blood-borne infections; Chronic kidney failure; Epidemiology; Sepsis; Sepsis epidemiology.