Frailty increases UTI risk in patients with diabetes and CKD: Study
Taiwan: A recent study found frailty in patients with diabetes mellitus (DM) and chronic kidney disease (CKD) to be associated with an increased risk of urinary tract infection (UTI). The study findings appear in the journal BMC Geriatrics.
Previous studies have shown CKD and diabetes to be at increased risk of UTI due to their altered immunological integrity. These patients are similarly prone to the development of frailty, a state of cumulative health deficits involving multiple domains and leading to adverse outcomes. However, this is unclear if frailty predisposes affected people to UTI among patients with CKD and diabetes.
Against the above background, Jenq-Wen Huang, National Taiwan University Hospital Yunlin branch, Yunlin county, Taiwan, and colleagues hypothesized that having frailty might place patients with DM and CKD at an even higher risk of UTI compared to those with DM and CKD but without frailty. The researchers attempted to answer this question using a well-characterized population-based cohort of patients with DM.
For this purpose, the researchers assembled a population-based cohort of patients with DM and CKD (n = 79,887) from the Longitudinal Cohort of Diabetes Patients, with their baseline frailty status measured by a modified FRAIL scale. Their risk of developing UTI was analyzed depending on their severity of frailty, after accounting demographic profiles, lifestyle factors, comorbidities, concurrent medications, and major interventions. A secondary analysis focused on the risk of urosepsis related to frailty.
Key findings of the study include:
- Among all participants, 36.1 %, 50.3 %, 12.8 %, and 0.8 % did not have or had 1, 2, and ≥ 3 FRAIL items, respectively, at baseline.
- After 3.51 years, 11,175 UTI events occurred.
- Kaplan-Meier analysis showed that participants with DM, CKD and an increasing number of FRAIL items had successively higher incidence of UTI than those without any FRAIL items.
- Cox proportional hazard modeling revealed that after accounting for all confounders, those with more severe frailty exhibited a significantly higher risk of incident UTI (for groups of 1, 2, and ≥ 3 FRAIL items, hazard ratio 1.19, 1.24, and 1.43, respectively) than those without.
- An 11 % risk elevation for UTI could be observed for every FRAIL item increase.
- Participants with more severe frailty exhibited a trend of having higher risk of urosepsis as well.
"Considering the risk, it would be prudent to screen for frailty in these patients and provide optimal frailty-directed management to attenuate their risk of UTI and improve their outcomes," wrote the authors.
Reference:
The study titled, "Frailty increases the risk for developing urinary tract infection among 79,887 patients with diabetic mellitus and chronic kidney disease," is published in the journal BMC Geriatrics.
DOI: https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02299-3
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