BERKELEY, CA (UroToday.com) - The consequences of urinary tract infection (UTI) in diabetic patients are serious. For diabetic patients with UTI, there is 4-fold risk of bacteremia, 3- to 5-fold in hospitalization, and a greater mortality rate (7.6% versus 1.6%) than non-diabetic patients with UTI. Diabetic nephropathy is the leading cause of end-stage renal disease in the world.
The aim of our study, investigating diabetic patients with UTIs admitted between 2001 and 2011, was to clarify the impact on renal function from episodic UTI in diabetic patients. We excluded patients with untreated obstructive uropathy, with incomplete data, patients who were dialysis-dependent during their hospital stay, and those with recurrent UTI during the investigation period. Continuous (from 12-months before admission to 6-months after discharge) and categorical variables were analyzed separately for the early- and late-stage groups using Student t test (or the Mann–Whitney U test) and the chi-square test (or Fisher's exact test).
We found that the levels of eGFR decline were more significant and rapid for diabetic patients in late-stage CKD (eGFR less than 30 ml/min) with UTI -- even without bacteremia -- than diabetic patients in early-stage CKD (eGFR more than 30 ml/min). Gram-positive or Gram-negative bacteria had similar adverse impact on renal outcomes, and patients, after having been cured of their UTIs, would revert to their eGFR trend in the subsequent 6 months. Poor DM control could contribute to admission for UTI in both early- and late-stage CKD patients (glycosylated hemoglobin: (9.7±2.8% versus 8.6±2.6%).
We recommended thoroughly educating patients on UTI prevention, early recognition of complicating AKI factors, and aggressive treatment for symptomatic UTI.
The limitations of our study:
- We focused in the impact of episodic UTI on renal outcomes. The risk of AKI in diabetic patients should be underscored.
- This is a hospital-based retrospective cohort study and patient numbers were small.
- For retrospective study, the effects between different treatment regimens on renal outcome could not be estimated.
- Nutrition is a confounding factor for serum creatinine, and eGFR will be overestimated in the case of malnutrition after infection disease.
Written by:
Chia-Chu Chang as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan
Long-term renal outcomes of episodic urinary tract infection in diabetic patients - Abstract
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