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VOLUME 28 , ISSUE 6 ( June, 2024 ) > List of Articles

Original Article

Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India

Arun Prabhahar, Niranjan A Vijaykumar, Suresh Selvam, Raja Ramchandran, Jasmine Sethi, Ashok Pannu, Navneet Sharma

Keywords : Chronic kidney disease, Emergency, Hemodialysis, Infections, Mortality, Pneumonia, Urinary tract infection

Citation Information : Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu A, Sharma N. Characteristics and Prognosis of Infectious Disease Emergencies in Patients with Chronic Kidney Disease in India. Indian J Crit Care Med 2024; 28 (6):601-606.

DOI: 10.5005/jp-journals-10071-24731

License: CC BY-NC 4.0

Published Online: 31-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Objectives: Chronic kidney disease (CKD) significantly increases the risk of infectious diseases (IDs), leading to heightened morbidity and mortality. However, there remains a lack of detailed, region-specific studies. This study investigates the clinical spectrum, etiologies, outcomes, and baseline predictors of mortality of ID emergencies in CKD patients in North India. Methods: This retrospective study was conducted at the Postgraduate Institute of Medical Education and Research, Chandigarh, from January 2021 to December 2022. It included patients aged ≥13 years with CKD and IDs admitted to the Acute Care and Emergency Medicine Unit. Results: We enrolled 248 patients (mean age 50 years, 58.1% males). About 60% had CKD stage 5, and 46% were on maintenance hemodialysis. Diabetic kidney disease was the predominant etiology (38.7%). The principal IDs were pneumonia (27.4%), urinary tract infection (UTI) (21.4%), sepsis of unknown primary focus (15.7%), tuberculosis (8.1%), and multisite infections (7.7%). Patients commonly have atypical clinical presentation, e.g., absence of fever and nonspecific symptoms such as shortness of breath and altered mental status. An emergence of multidrug-resistant organisms, e.g., Enterococcus faecium for UTI and Stenotrophomonas maltophilia for catheter-related bloodstream infections, was noted. In-hospital mortality rate was 33.5%, higher with multisite infections (58%) and pneumonia (47%). A low baseline Glasgow coma scale (GCS) was an independent predictor of mortality [odds ratio (OR) 0.786, 95% confidence interval (CI) 0.693–0.891, p-value <0.001]. Conclusion: Effective management and early intervention are needed to improve outcomes in CKD patients with ID emergencies, given the high mortality and atypical clinical presentations.


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