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

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.

How to cite this article: Prabhahar A, Vijaykumar NA, Selvam S, Ramchandran R, Sethi J, Pannu AK, et al. 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.