# Modifiable Risk Factors for Infection among Patients with Chronic Kidney Disease

> **NIH NIH F32** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $69,050

## Abstract

Chronic kidney disease (CKD) is a common, debilitating public health issue, affecting 38 million
adults in the U.S. CKD is associated with many adverse outcomes and has been associated
with a higher risk of hospitalization for infection, as well as increased mortality from infection.
The risk factors that lead patients with CKD to be at increased risk for infection are unknown. In
patients with end stage renal disease on dialysis, metabolic acidosis leads to impaired
neutrophil function, and secondary hyperparathyroidism leads to impaired phagocytosis. The
etiology of CKD may affect risk for infection as patients with diabetes have an increased risk for
infection compared to the general population. No longitudinal studies have investigated
modifiable risk factors for infection among patients with CKD. We therefore propose to highlight
potential causal associations between acid-base status, secondary hyperparathyroidism,
etiology of CKD and risk for infection requiring hospitalization among patients with CKD. In Aims
1a and 1b we will conduct a cohort study to examine the association between acid-base status
as well as secondary hyperparathyroidism and incidence of infection requiring hospitalization
among patients with CKD. We will focus on four infections: pneumonia, urinary tract infection,
bacteremia, and cellulitis. We will utilize the Partners Research Patient Data Registry (RPDR), a
central data warehouse with ~ 40,000 patients with an eGFR <60 mL/min/1.73m2 between 2010
to present. Information on relevant covariates is also available in the RPDR. We will use
outpatient serum bicarbonate and parathyroid hormone (PTH) levels divided into categories to
compare the risk of infection requiring hospitalization. In Aim 1a we hypothesize that patients
with CKD with lower serum bicarbonate levels will have an increased incidence of infection
requiring hospitalization and in Aim 1b we hypothesize that patients with CKD with higher PTH
levels will have an increased incidence of infection requiring hospitalization. In Aim 2 we will
examine the association between etiology of CKD, established by renal biopsy or imaging, and
incidence of infection requiring hospitalization among patients with CKD. We will utilize a cohort
of ~1,400 patients in the RPDR database over a planned eleven-year study period who have
undergone renal biopsy. We hypothesize that patients with CKD and diabetic nephropathy will
have an independently higher risk of infection requiring hospitalization than patients with CKD
from hypertension or polycystic kidney disease. Collectively, these studies could have a major
impact on how we screen, manage, and treat patients with CKD who have factors that could
change their risk profile for infection requiring hospitalization.

## Key facts

- **NIH application ID:** 10068604
- **Project number:** 1F32DK126331-01
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Danielle Saly
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $69,050
- **Award type:** 1
- **Project period:** 2020-12-01 → 2021-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10068604

## Citation

> US National Institutes of Health, RePORTER application 10068604, Modifiable Risk Factors for Infection among Patients with Chronic Kidney Disease (1F32DK126331-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10068604. Licensed CC0.

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