Clinical epidemiology of infectious disease among patients with chronic kidney disease

Abstract

Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.

The Predictive Value of NT-Pro-Brain Natriuretic Peptide for Risk of Pneumonia in Patients on Maintenance Hemodialysis

“…Studies suggest that when kidney function is abnormal, the accumulation of uremic toxins can damage the immune system of patients with chronic kidney disease. This leads to increased susceptibility to infection [33].…”

Is the kidney a target of SARS-CoV-2?

“…Fortunately, recent studies have provided enough evidence showing that in patients treated with reninangiotensin system inhibitors, there is not greater risk of SARS-CoV-2 (44,59). However, patients with CKD, and especially those with end-stage renal disease and with renal replacement therapy, are known to have impaired immune function, and this could contribute to greater SARS-CoV-2 infection susceptibility (34). Additionally, kidney transplant recipients, who receive immunosuppressant therapy, may have a particular risk of acquiring COVID-19 (15a).…”

Toxoplasma infection in kidney donors and transplant recipients from Western Mexico: A one‐year follow‐up

“…Chronic kidney disease (CKD) patients are highly susceptible to infection due to inherent disease complication and medications. Uremic toxins contribute to an impaired immune system including reduced lymphocyte production, as well as impaired leukocyte and neutrophil functions . Additionally, diabetes and cardiovascular diseases are highly prevalent in this kind of patients, and these metabolic and vascular complications favor the risk of infections .…”

“…In severely immunosuppressed organ recipients, serological diagnosis could fail since the antibody response might be lacking or atypical. Additionally, this immunosuppressive state may favor toxoplasmosis transmission through an infected transplanted organ . Frequencies of T lymphocyte and monocyte subsets decrease significantly 2 weeks after transplantation due to immunosuppressive therapy, increasing the risk of cyst reactivation in immunocompromised recipients with latent infection or in cases where the transplanted organ is infected with T gondii .…”

“…Additionally, this immunosuppressive state may favor toxoplasmosis transmission through an infected transplanted organ . Frequencies of T lymphocyte and monocyte subsets decrease significantly 2 weeks after transplantation due to immunosuppressive therapy, increasing the risk of cyst reactivation in immunocompromised recipients with latent infection or in cases where the transplanted organ is infected with T gondii . Fatal encephalitis, myocarditis, pneumonitis, chorioretinitis, and generalized lymphadenopathy have been reported in immunocompromised recipients transplanted with solid organs and in patients with AIDS .…”