Supplementary Material for: Chronic Kidney Disease and Risk of Death from Infection

<i>Background:</i> Infection, bacteremia and sepsis are major sources of morbidity and mortality in patients with end-stage renal disease. This study sought to determine the association between predialysis chronic kidney disease (CKD) and infection-related mortality. <i>Methods:</i> We analyzed participants in the Third National Health and Nutrition Examination Survey (NHANES III). The study included adults ≧45- years-old without end-stage renal disease. Estimated glomerular filtration rate (eGFR) was categorized as ≧60, 45–59.9 and &lt;45 ml/min per 1.73 m², and urinary albumin-to-creatinine ratio (ACR) as &lt;30, 30–299.9 and ≧300 mg/g. The study identified infection-related mortality, including septicemia, respiratory, abdominal and gastrointestinal, cardiac, kidney and genitourinary, neurologic, and other infections over a median of 13 years using the National Death Index. <i>Results:</i> Of 7,400 participants included in the study, 206 died from infections. Compared to individuals with eGFR ≧60 ml/min per 1.73 m², infection-related mortality was higher for those with lower eGFR [adjusted HR = 1.36 (95% CI: 0.81, 2.30) and 2.36 (1.04, 5.38) for eGFR of 45–59.9 and &lt;45 ml/min per 1.73 m², respectively; p trend = 0.06]. Compared to individuals with ACR &lt;30 mg/g, infection-related mortality was higher for ACR levels of 30–299 and ≧300 mg/g [adjusted HR = 1.68 (95% CI: 0.97, 2.92) and 2.84 (0.92, 8.74), p trend = 0.02]. <i>Conclusions:</i> Reduced eGFR and albuminuria are associated with increased risk for infection-related mortality. Efforts are needed to reduce its incidence and mitigate the effects of infections among individuals with CKD.

背景：感染、菌血症与败血症是终末期肾病患者发病与死亡的主要诱因。本研究旨在探讨透析前慢性肾脏病（chronic kidney disease, CKD）与感染相关死亡之间的关联。方法：本研究分析了第三次全国健康与营养检查调查（Third National Health and Nutrition Examination Survey, NHANES III）的参与者数据，纳入对象为年龄≥45岁且无终末期肾病的成年人。将估算肾小球滤过率（estimated glomerular filtration rate, eGFR）按以下标准分层：≥60、45~59.9以及<45 ml/min/1.73m²；尿白蛋白肌酐比（albumin-to-creatinine ratio, ACR）分层标准为<30、30~299.9以及≥300 mg/g。通过国家死亡索引（National Death Index），本研究在中位随访13年的周期内，统计了包括败血症、呼吸系统、腹部及胃肠道、心血管、肾脏与泌尿生殖系统、神经系统及其他感染在内的感染相关死亡病例。结果：本研究共纳入7400名参与者，其中206例死于感染。与eGFR≥60 ml/min/1.73m²的人群相比，eGFR更低的群体感染相关死亡风险更高[eGFR为45~59.9及<45 ml/min/1.73m²者的校正后风险比（hazard ratio, HR）分别为1.36（95%置信区间（confidence interval, CI）：0.81, 2.30）和2.36（1.04, 5.38）；趋势检验p值=0.06]。与ACR<30 mg/g的人群相比，ACR为30~299.9 mg/g及≥300 mg/g的群体感染相关死亡风险更高[校正后HR=1.68（95%CI：0.97, 2.92）和2.84（0.92, 8.74），趋势检验p值=0.02]。结论：估算肾小球滤过率降低与白蛋白尿均与感染相关死亡风险升高存在关联。亟需采取措施降低慢性肾脏病患者的感染发生率，并减轻感染对该群体造成的不良影响。