British researchers have found a high burden of infections among older adults with diabetes who have chronic kidney disease (CKD) not treated by dialysis or a kidney transplant.

Reduced estimated glomerular filtration rate (eGFR) and, novelly, a history of proteinuria were independent risk factors for lower respiratory tract infections (such as influenza and bronchitis), pneumonia, and sepsis.

The findings “appeared to be due in part to underlying accrued cardiovascular and cerebrovascular comorbid conditions,” the researchers stated. Still, a strong association remained after adjustment for these conditions.

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For the study, investigators led by Helen I. McDonald, BM BCh MSc, of the London School of Hygiene & Tropical Medicine analyzed data for more than 191,000 diabetes patients age 65 or older with non-dialysis CKD from the United Kingdom’s Clinical Practice Research Datalink 1997–2011.

They found strong graded associations between lower eGFR and community-acquired infections, according to results published online ahead of print in the American Journal of Kidney Diseases. Sepsis was up to 5.5 times more prevalent among patients with an eGFR below 60 mL/min/1.73 m2.  Patients with impaired kidney function also had 1 to 3 times more cases of pneumonia. The chances of lower respiratory tract infections were also elevated.

These findings can help clinicians identify patients at risk of infection and prompt discussions about possibly helpful vaccinations, according to the researchers.

Treatment may raise the risk of infection in CKD patients receiving renal replacement therapy, the researchers noted. This study and others add that diabetes patients with early-stage CKD not requiring dialysis have elevated risks. 


  1. McDonald, H, et al. Am J Kidney Dis. 2015; doi: 10.1053/j.ajkd.2014.11.027.