الفهرس 
Chronic Kidney DiseaseOnly 14 pages are availabe for public view
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Abstract
Globally, pneumonia is a leading cause of death. In 2013, lower respiratory infections were the second leading cause of death globally. Annual pneumonia rates of up to 14 per 1000 people place a heavy financial and medical burden on most healthcare systems. Because of this, most clinicians still struggle greatly to control that pathology.
Pneumonia in CKD patients is often hospitalized. Numerous studies support CKD patients’ increased risk of pneumonia and pneumonia-related mortality. The reduction of antigen-presenting cells and the malfunctioning of immune cells may be responsible for this. The existence of vascular access, injectable drugs, dialyzers, and other equipment that is shared with other patients are additional risk factors for patients getting hemodialysis.
Pneumonia is linked to worse outcomes, even in patients with acute kidney damage (AKI). That might draw attention to the link between kidney illness and unfavourable pneumonia outcomes.
Lack of studies on pneumonia prevalence and risk factors in CKD patients. The majority of earlier investigations dealt with general infectious problems in these patients. That was a fair motive for us to conduct the present study.
32% of pneumonia patients smoked, compared to 17.3% of non-pneumonia patients.
The 350 patients were split into two groups based on the incidence of pneumonia; the first group consisted of CKD patients who developed pneumonia, and the second group consisted of the remaining patients who did not.
The information about these patients was examined from our medical archive, and the information gathered included the following: patient age, gender, body mass index (BMI), smoking status, systemic comorbidities (diabetes mellitus, hypertension, asthma, ischemic heart disease, and chronic obstructive pulmonary disease or COPD), duration of CKD, disease stage, aetiology of CKD, the incidence of pneumonia, presentation of pneumonia, laboratory workup at the time
Our study revealed the following findings:
• Among the included 350 patients included and diagnosed with CKD, 50 patients had pneumonia, with an incidence rate of 14.29%.
• The two groups’ mean ages of the included cases were 56.04 and 50.45 years old, respectively, with a markedly higher proportion of pneumonia patients.
• Women significantly outnumbered men in the pneumonia group. (62 percent vs. 36.3 percent in the other group), which, according to statistical analysis, was significant.
• BMI had mean values of 24.09 and 28.42 kg/m2 in the pneumonia and non-pneumonia groups, with a significant decline in the former.
• 32% of pneumonia patients smoked, compared to 17.3% of non-pneumonia patients.
• diabetes mellitus was present in 44% and 21.3%, whereas hypertension was present in 72% and 63.7% of patients in the pneumonia and non-pneumonia groups respectively.
• 14% and 5% of patients had asthma, while 32% and 17.3% had COPD.
• Statistically, 10% and 12.7% of the same groups had ischemic heart disease.
• In the pneumonia group, CKD lasted longer (6.54 vs 4.95 years in the non-pneumonia group).
• 54% of pneumonia patients and 32% of non-pneumonia patients had stage V disease, indicating that pneumonia patients had higher CKD stages (p = 0.001).
• The two groups had similar CKD aetiologies.
• Regarding the clinical presentation of patients with pneumonia, cough with expectoration was the most common manifestation (72%), followed by tachypnoea (50%), fever and tachycardia (48%). Other presentations included chest pain (34%) and septic shock (10%).
• The total leucocytic count of pneumonia cases had a mean value of 13.01 (range, 7.7 – 17.5).
• Streptococcus pneumonia was the most common causative organism (34%), followed by klebsiella (16 percent ). Other organisms included staphylococcus aureus (8%), haemophilus influenza (6%), pseudomonas aeruginosa (4%), proteus (4%), and actinobacter (4%), while mixed anerobic organisms and fungi were detected in 8% and 4% of cases respectively. No growth was noted in six patients (12%).
• Patients with pneumonia spent an average of 13.58 days in the hospital (between 7 and 20 days).
• ICU admission was required for 18 patients (36%), while mechanical ventilation was done for 12 patients (24%).
• Mortality was encountered in eleven cases who caught pneumonia in the current study (22%).
• On univariate analysis, old age, female gender, low BMI, smoking, diabetes mellitus, hypertension, asthma, COPD, increased CKD duration, and stage V disease were significant risk factors for pneumonia in CKD patients.
• In a multivariate analysis, COPD, asthma, and hypertension lost some of their significance, while the other previous parameters retained it.
Conclusion
Based on the results of our study, one can conclude that:
• The incidence of pneumonia is not low in CKD patients, and Streptococcus pneumonia is the most common etiological organism.
• Older age, female gender, smoking, diabetes mellitus, increased duration of CKD disease, and high CKD stage were independent predictors of having pneumonia in such patients..
Recommendation
• In the near future, more researches involving more patients from various nephrology centres needs to be done.
• CKD patients with the previously mentioned risk factors should be closely monitored for early manifestations of chest infections, for early diagnosis and treatment.
• Screening programs for chest infections should be done for patients with multiple risk factors.