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Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention.

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  • Additional Information
    • Author(s):
    • Address:
      Inghesalen, floor 2, Widerströmska huset, Tomtebodavägen 18A, Karolinska Institute, Solna, Sweden.
    • Publication Information:
      Sweden
    • Abstract:
      The thesis consists of two observational studies (Paper I & II), one cohort study (Paper III) and one systematic review and meta-analysis (Paper IV). Paper I, II & III explored the association between kidney function (defined as estimated glomerular filtration rate, eGFR) and various outcomes. These outcomes included microbial pattern (Paper I), prevalence of infections with multi-drug resistant organisms (MDROs) in the first positive microbial cultures (Paper I), intensive care unit admission (Paper II), length of hospital stay (Paper II), medical expense (Paper II), and mortality (Paper II & III). These were assessed in patients hospitalized with infections, using electronic medical records from four hospitals from 2012 to 2015 in China. Paper IV obtained data from existing literature to explore the association of infections with vitamin D status or use of vitamin D in patients treated with long-term dialysis. In adult patients hospitalized with infections, the proportion of Gram-negative bacteria decreased while the proportion of Gram-positive bacteria increased across eGFR strata. Compared with the reference eGFR, lower eGFR was associated with: higher odds of infections by MDROs (19% and 41% higher in those with eGFR between 30-59 ml/min/1.73 m2 and eGFR <30 ml/min/1.73 m2, respectively) (Paper I); more than twofold higher adjusted odds of ICU admission, longer median length of hospital stay (P< 0.001), inferred 20.0% higher costs in those with eGFR< 60 ml/min/1.73 m2 (P< 0.001) (Paper II); progressively increased risks of cardiovascular mortality (subdistribution hazard ratio [SHR] 2.15 for eGFR 30-59 mL/min/1.73m2; SHR 3.19 for eGFR<30 mL/min/1.73m2) (Paper III). In the systematic review of vitamin D and infections in patients treated with long-term dialysis, the risk of composite infections was 39% lower in those with high/normal levels of 25-hydroxy vitamin D than that in those with low levels. Compared to those who did not use vitamin D, the pooled adjusted risk of composite infection was 41% lower in those who used vitamin D (Paper IV). CKD patients hospitalized with infections have a higher risk of infections by MDROs, poorer in-hospital outcomes resulting in higher medical costs and increased risk of cardiovascular mortality in the long-run. Use of vitamin D to achieve high/normal serum levels of 25(OH)-vitamin D might help lowering the risk of infections in maintenance dialysis patients. Further research is needed to investigate the potential role of vitamin D therapy in infection prevention among non-dialysis dependent CKD patients.
    • Number of References:
      160 ref.
    • Subject Terms:
      Tropical Diseases
    • Subject Terms:
    • Accession Number:
      observational studies, bacterium, circulatory system, People's Republic of China, costings, gram-negative bacteria, gram-positive bacteria, hemodialysis, kidney disorders, nephropathy, renal diseases, death rate, nutritional status, kidney function
    • CABICODES:
      Non-communicable Human Diseases and Injuries (VV600)
      Non-drug Therapy and Prophylaxis of Humans (VV710) (New March 2000)
      Prion, Viral, Bacterial and Fungal Pathogens of Humans (VV210) (New March 2000)
    • Accession Number:
      1406-16-2
    • Publication Information:
      Thesis; URL:https://openarchive.ki.se/xmlui/handle/10616/46666
    • Accession Number:
      20203185814
    • Copyright:
      ©2019 CAB International
  • Citations
    • ABNT:
      SU GUOBIN. Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention. 2019. Karolinska Institutet, Stockholm; Sweden, 2019. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814. Acesso em: 27 set. 2020.
    • AMA:
      Su GuoBin. Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention. Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention. 2019:87. Accessed September 27, 2020. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814
    • APA:
      Su GuoBin. (2019). Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention [Karolinska Institutet]. In Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention (p. 87).
    • Chicago/Turabian: Author-Date:
      Su GuoBin. 2019. “Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention.” Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention. Stockholm; Sweden: Karolinska Institutet. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814.
    • Harvard:
      Su GuoBin (2019) Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention, Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention. Karolinska Institutet. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814 (Accessed: 27 September 2020).
    • Harvard: Australian:
      Su GuoBin 2019, ‘Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention’, Karolinska Institutet, Stockholm; Sweden, Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention, p. 87, viewed 27 September 2020, .
    • MLA:
      Su GuoBin. “Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention.” Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention, Karolinska Institutet, 2019, p. 87. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814.
    • Chicago/Turabian: Humanities:
      Su GuoBin. “Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention.” Infections in Patients with Chronic Kidney Disease: Patterns, Outcomes and the Role of Vitamin D for Future Prevention. Karolinska Institutet, 2019. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814.
    • Vancouver/ICMJE:
      Su GuoBin. Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention [Internet]. Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention. [Stockholm; Sweden]: Karolinska Institutet; 2019 [cited 2020 Sep 27]. p. 87. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=lhh&AN=20203185814