Infection-related acute care events among patients with glomerular disease

Background and objectives Infections contribute to patient morbidity and mortality in glomerular disease. We sought to describe the incidence of, and identify risk factors for, infection-related acute care events among Cure Glomerulonephropathy Network (CureGN) study participants. Design, setting, participants, & measurements CureGNis a prospective,multicenter, cohort study of children and adults with biopsy sample–proven minimal change disease, FSGS, membranous nephropathy, or IgA nephropathy/vasculitis. Risk factors for time to first infection-related acute care events (hospitalization or emergency department visit) were identified using multivariable Cox proportional hazards regression. ResultsOf 1741 participants (43%female, 41%,18 years, 68%White), 163 (9%) experiencedinfection-related acute careeventsover amedian follow-upof 17months (interquartile range, 9–26months).Unadjusted incidence ratesof infection-related acute care events were 13.2 and 6.2 events per 100 person-years among pediatric and adult participants, respectively. Among participants with versus without corticosteroid exposure at enrollment, unadjusted incidence rates were 50.6 and 28.6 per 100 person-years, respectively, during the first yearof follow-up (adjusted hazard ratio for time to first infection, 1.31; 95% CI, 0.89 to 1.93), and 4.1 and 1.1 per 100 person-years, respectively, after 1 year of follow-up (hazard ratio, 2.99; 95%CI, 1.54 to 5.79). Hypoalbuminemia combinedwith nephrotic-range proteinuria (serum albumin #2.5 g/dl and urinary protein-creatinine ratio.3.5 mg/mg), compared with serumalbumin.2.5 g/dl and urinary protein-creatinine ratio#3.5 mg/mg, was associatedwith higher risk of time to first infection (adjusted hazard ratio, 2.49; 95% CI, 1.51 to 4.12). Conclusions Among CureGNparticipants, infection-related acute care eventswere common and associatedwith younger age, corticosteroid exposure, and hypoalbuminemia with proteinuria.