Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

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 K 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 AK, 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.


HTML PDF Share
  1. Dalrymple LS, Go AS. Epidemiology of acute infections among patients with chronic kidney disease. Clin J Am Soc Nephrol 2008;3(5):1487–1493. DOI: 10.2215/CJN.01290308.
  2. Wang HE, Gamboa C, Warnock DG, Muntner P. Chronic kidney disease and risk of death from infection. Am J Nephrol 2011;34(4):330–336. DOI: 10.1159/000330673.
  3. Chang CH, Fan PC, Kuo G, Lin Y, Tsai T, Chang S, et al. Infection in advanced chronic kidney disease and subsequent adverse outcomes after dialysis initiation: A nationwide cohort study. Sci Rep 2020;10(1):2938. DOI: 10.1038/s41598-020-59794-7.
  4. Cheikh Hassan HI, Tang M, Djurdjev O, Langsford D, Sood MM, Levin A. Infection in advanced chronic kidney disease leads to increased risk of cardiovascular events, end-stage kidney disease and mortality. Kidney Int 2016;90(4):897–904. DOI: 10.1016/j.kint.2016.07.013.
  5. Allon M, Radeva M, Bailey J, Beddhu S, Butterly D, Coyne DW, et al. The spectrum of infection-related morbidity in hospitalized haemodialysis patients. Nephrol Dial Transplant 2005;20(6):1180–1186. DOI: 10.1093/ndt/gfh729.
  6. Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease. Adv Chronic Kidney Dis 2019;26(1):8–15. DOI: 10.1053/j.ackd.2019.01.004.
  7. Cohen G. Immune dysfunction in uremia 2020. Toxins (Basel) 2020;12(7):439. DOI: 10.3390/toxins12070439.
  8. Allon M, Depner TA, Radeva M, Bailey J, Beddhu S, Butterly D, et al. Impact of dialysis dose and membrane on infection-related hospitalization and death: Results of the HEMO study. J Am Soc Nephrol 2003;14(7):1863–1870. DOI: 10.1097/01.asn.0000074237.78764.d1.
  9. Naqvi SB, Collins AJ. Infectious complications in chronic kidney disease. Adv Chronic Kidney Dis 2006;13(3):199–204. DOI: 10.1053/j.ackd.2006.04.004.
  10. Scherberich JE, Fünfstück R, Naber KG. Urinary tract infections in patients with renal insufficiency and dialysis – Epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment. GMS Infect Dis 2021;9:Doc07. DOI: 10.3205/id000076.
  11. Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients: Incidence, risk factors, and prognosis. Kidney Int 1999;55(3):1081–1090. DOI: 10.1046/j.1523-1755.1999.0550031081.x.
  12. Alemu A, Bitew ZW, Diriba G, Seid G, Eshetu K, Chekol MT, et al. Tuberculosis incidence in patients with chronic kidney disease: A systematic review and meta-analysis. Int J Infect Dis 2022;122:188–201. DOI: 10.1016/j.ijid.2022.05.046.
  13. Pannu AK, Saroch A, Kumar M, Behera A, Nayyar GS, Sharma N. Quantification of chronic diseases presenting in the Emergency Department and their disposition outcomes: A hospital-based cross-sectional study in North India. Trop Doct 2022;52(2):276–279. DOI: 10.1177/00494755211069450.
  14. Poddar A, Selvam S, Saroch A, Pannu AK, Mathen PG, Kumar M, et al. Medical emergencies and comorbidities in the elderly and very elderly patients in North India. Int J Noncommun Dis 2023;8(2):75–83. DOI: 10.4103/jncd.jncd_15_23.
  15. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl 2013;3(1):5–14. DOI: 10.1038/kisup.2012.77.
  16. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired Pneumonia. An official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med 2019;200(7):e45–e67. DOI: 10.1164/rccm.201908-1581ST.
  17. Bonkat G, Bartoletti R, Bruyére F, Cai T, Geerlings SE, Köves B, et al. Urological infections. Arnhem: Eur Assoc Urol 2023. Available from: https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urological-infections-2023.pdf. Last accessed on: 29 May 2023.
  18. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: International guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181–1247. DOI: 10.1007/s00134-021-06506-y.
  19. O'Grady NP. Prevention of central line-associated bloodstream infections. N Engl J Med 2023;389(12):1121–1131. DOI: 10.1056/NEJMra2213296.
  20. Central TB Division, Ministry of Health & Family Welfare, Government of India. Guidelines: Technical and Operational Guidelines for TB Control in India 2016. New Delhi, Central TB Division, Ministry of Health and FamilyWelfare, Government of India, 2016. Available from: https://tbcindia.gov.in/index1.php?sublinkid= 5129&level=2&lid=3177&lang=1. Last accessed on: 29 May 2023.
  21. Kumar D, Pannu AK, Dhibar DP, Singh R, Kumari S. The epidemiology and clinical spectrum of infections of the central nervous system in adults in north India. Trop Doct 2021;51(1):48–57. DOI: 10.1177/0049475520959905.
  22. Pannu AK. Circulatory shock in adults in emergency department. Turk J Emerg Med 2023;23(3):139–148. DOI: 10.4103/2452-2473. 367400.
  23. Kumar V, Yadav AK, Sethi J, Ghosh A, Sahay M, Prasad N, et al. The Indian Chronic Kidney Disease (ICKD) study: Baseline characteristics. Clin Kidney J 2021;15(1):60–69. DOI: 10.1093/ckj/sfab149.
  24. Su G, Iwagami M, Qin X, McDonald H, Liu X, Carrero JJ, et al. Kidney disease and mortality in patients with respiratory tract infections: A systematic review and meta-analysis. Clin Kidney J 2020;14(2):602–611. DOI: 10.1093/ckj/sfz188.
  25. Pannu AK, Kumar M, Singh P, Shaji A, Ghosh A, Behera A, et al. Severe acute respiratory infection surveillance during the initial phase of the COVID-19 outbreak in North India: A comparison of COVID-19 to other SARI causes. Indian J Crit Care Med 2021;25(7):761–767. DOI: 10.5005/jp-journals-10071-23882.
  26. Sasaki S, Raita Y, Murakami M, Yamamoto S, Tochitani K, Hasegawa T, et al. Added value of clinical prediction rules for bacteremia in hemodialysis patients: An external validation study. PLoS One 2021;16(2):e0247624. DOI: 10.1371/journal.pone.0247624.
  27. Rahman N, Yadav R, Sethi S, Saroch A, Behera A, Bhalla A, et al. Clinical spectrum and outcomes of geriatric tuberculosis emergencies in North India. Turk J Emerg Med 2021;21(3):91–97. DOI: 10.4103/2452-2473.320800.
  28. Pannu AK, Saroch A, Singla V, Sharma N, Dutta P, Jain A, et al. Clinical spectrum, etiology and outcome of infectious disease emergencies in adult diabetic patients in Northern India. Diabetes Metab Syndr 2020;14(5):921–925. DOI: 10.1016/j.dsx.2020.06.004.
  29. Pannu AK, Kumar A, Kiran R, Bhatia M, Sharda SC, Saroch A, et al. Diagnostic utility of procalcitonin for bacterial infections in diabetic ketoacidosis. Clin Exp Med 2023;23(8):5299–5306. DOI: 10.1007/s10238-023-01169-z.
  30. Pal S, Sharma N, Singh SM, Kumar S, Pannu AK. A prospective cohort study on predictors of mortality of delirium in an emergency observational unit. QJM 2021;114(4):246–251. DOI: 10.1093/qjmed/hcaa183.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.