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A national cohort study examined the risk of severe infection and infection-related mortality in patients with chronic kidney disease with lupus nephritis in comparison to other chronic kidney disease etiologies

Chrysostomou, Charikleia ; Faustini, Francesca ; Segelmark, Mårten LU orcid ; Carrero, Juan Jesús ; Gunnarsson, Iva ; Barany, Peter ; Evans, Marie and Faucon, Anne Laure (2026) In Kidney International 109(2). p.379-389
Abstract

Introduction: The co-occurrence of lupus nephritis (LN) and chronic kidney disease (CKD) is associated with an excess risk of infection. However, it remains unknown whether the infection risk differs between LN with moderate and advanced CKD (LN-CKD) and other CKD etiologies. Methods: Using data from the Swedish Renal registry 2006-2021, we identified 14,128 patients (median age 68 years, 64% men, median estimated glomerular filtration rate 25 ml/min per 1.73m2) that included 317 patients with LN-CKD, 783 patients with anti-neutrophil cytoplasm antibodies (ANCA) vasculitis, 8877 patients with diabetic kidney disease (DKD), 1855 patients with autosomal dominant polycystic kidney disease (ADPKD) and 2296 patients with primary... (More)

Introduction: The co-occurrence of lupus nephritis (LN) and chronic kidney disease (CKD) is associated with an excess risk of infection. However, it remains unknown whether the infection risk differs between LN with moderate and advanced CKD (LN-CKD) and other CKD etiologies. Methods: Using data from the Swedish Renal registry 2006-2021, we identified 14,128 patients (median age 68 years, 64% men, median estimated glomerular filtration rate 25 ml/min per 1.73m2) that included 317 patients with LN-CKD, 783 patients with anti-neutrophil cytoplasm antibodies (ANCA) vasculitis, 8877 patients with diabetic kidney disease (DKD), 1855 patients with autosomal dominant polycystic kidney disease (ADPKD) and 2296 patients with primary glomerular disease (PGD). Multivariable Poisson models and cause-specific Cox proportional hazards regressions were used to compare the risk of all-cause- and site-specific infection-related hospitalizations (including sepsis, respiratory-, genitourinary-, gastrointestinal related infections and infection of other/unspecified sites), and death due to infection, between patients with LN-CKD and the other CKD etiologies. Results: In LN-CKD, the three-year absolute risks of all-cause infection-related hospitalization and death due to infection were 31% and 4% respectively. The risk of all-cause infection-hospitalization was higher in LN-CKD than in ANCA vasculitis but similar between LN-CKD and DKD. LN-CKD was associated with a higher risk of all-cause infection-related hospitalization and death due to infection than ADPDK (adjusted hazard ratio 1.46 [1.18-1.8] and 2.47 [1.35-4.5], respectively) and PGD (1.90 [1.54-2.34] and 2.97 [1.71- 5.18], respectively). The results were consistent across the site-specific infection-related hospitalizations. Conclusions: Patients with LN exhibited a higher risk of severe infection compared to patients with ANCA vasculitis, ADPKD and PGD. LN-CKD and DKD had similar infection-risks. This highlights the need for prevention and tailored immunosuppressive therapy in the LN-population with CKD.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
chronic kidney disease, death due to infection, immunosuppression, infection-related hospitalization, lupus nephritis, sepsis
in
Kidney International
volume
109
issue
2
pages
11 pages
publisher
Nature Publishing Group
external identifiers
  • scopus:105027248401
  • pmid:41276017
ISSN
0085-2538
DOI
10.1016/j.kint.2025.10.010
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 International Society of Nephrology
id
881e55d7-832e-4b33-a407-2d71db132899
date added to LUP
2026-03-09 13:31:12
date last changed
2026-03-09 13:31:21
@article{881e55d7-832e-4b33-a407-2d71db132899,
  abstract     = {{<p>Introduction: The co-occurrence of lupus nephritis (LN) and chronic kidney disease (CKD) is associated with an excess risk of infection. However, it remains unknown whether the infection risk differs between LN with moderate and advanced CKD (LN-CKD) and other CKD etiologies. Methods: Using data from the Swedish Renal registry 2006-2021, we identified 14,128 patients (median age 68 years, 64% men, median estimated glomerular filtration rate 25 ml/min per 1.73m<sup>2</sup>) that included 317 patients with LN-CKD, 783 patients with anti-neutrophil cytoplasm antibodies (ANCA) vasculitis, 8877 patients with diabetic kidney disease (DKD), 1855 patients with autosomal dominant polycystic kidney disease (ADPKD) and 2296 patients with primary glomerular disease (PGD). Multivariable Poisson models and cause-specific Cox proportional hazards regressions were used to compare the risk of all-cause- and site-specific infection-related hospitalizations (including sepsis, respiratory-, genitourinary-, gastrointestinal related infections and infection of other/unspecified sites), and death due to infection, between patients with LN-CKD and the other CKD etiologies. Results: In LN-CKD, the three-year absolute risks of all-cause infection-related hospitalization and death due to infection were 31% and 4% respectively. The risk of all-cause infection-hospitalization was higher in LN-CKD than in ANCA vasculitis but similar between LN-CKD and DKD. LN-CKD was associated with a higher risk of all-cause infection-related hospitalization and death due to infection than ADPDK (adjusted hazard ratio 1.46 [1.18-1.8] and 2.47 [1.35-4.5], respectively) and PGD (1.90 [1.54-2.34] and 2.97 [1.71- 5.18], respectively). The results were consistent across the site-specific infection-related hospitalizations. Conclusions: Patients with LN exhibited a higher risk of severe infection compared to patients with ANCA vasculitis, ADPKD and PGD. LN-CKD and DKD had similar infection-risks. This highlights the need for prevention and tailored immunosuppressive therapy in the LN-population with CKD.</p>}},
  author       = {{Chrysostomou, Charikleia and Faustini, Francesca and Segelmark, Mårten and Carrero, Juan Jesús and Gunnarsson, Iva and Barany, Peter and Evans, Marie and Faucon, Anne Laure}},
  issn         = {{0085-2538}},
  keywords     = {{chronic kidney disease; death due to infection; immunosuppression; infection-related hospitalization; lupus nephritis; sepsis}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{379--389}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Kidney International}},
  title        = {{A national cohort study examined the risk of severe infection and infection-related mortality in patients with chronic kidney disease with lupus nephritis in comparison to other chronic kidney disease etiologies}},
  url          = {{http://dx.doi.org/10.1016/j.kint.2025.10.010}},
  doi          = {{10.1016/j.kint.2025.10.010}},
  volume       = {{109}},
  year         = {{2026}},
}