Published: 2019-03-28 10:58 | Updated: 2019-05-13 13:21

New thesis about infections in patients with chronic kidney disease and its implications for public health

Hi there Guobin Su, doctoral student at the Department of Public Health Sciences at Karolinska Institutet. On Thursday 4 April 2019 you defended your thesis "Infections in patients with chronic kidney disease: patterns, outcomes and the role of vitamin D for future prevention". What is the main focus of your thesis?

Guobin Su
Guobin Su.

“My thesis is about the heavy clinical and economic burden that infections put on patients with chronic kidney disease and its implication for public health, as well as strategies to reduce the risk of infections in this population.

Chronic kidney disease (CKD) is characterized of progressively impaired kidney structure and/or kidney function. If their kidney function declined to less than 10 %, patients with CKD usually requires either kidney transplantation or dialysis (hemodialysis or peritoneal dialysis), to support their life. As one in ten of the adult population has this disease, CKD has been increasingly recognized as a global public health problem. Higher risk of infection has been observed in patients with CKD.”

What are the most important findings?

“By analysing the data extracted from electronic medical records, we have found that patients with non-dialysis dependent chronic kidney disease (CKD) hospitalized with infections are more likely to contract infections with multi-drug resistant bacteria; have significantly increased risk of all-cause and cardiovascular mortality, longer hospital stay, resulting in higher health-care resource consumption.

In patients with CKD receiving chronic dialysis, lower serum levels of 25(OH)-vitamin D and use of vitamin D, particularly vitamin D receptor activators, were associated with a lower risk of infection.”

How can this knowledge be useful for improving people’s health?

“Our study has found that high/normal level of vitamin D is associated with lower risk of infection in dialysis patients. Strategies to increase the serum concentration of vitamin D, such as more sunshine exposure in a certain degree, may be encouraged. The use of vitamin D supplements (nutritional or vitamin D receptor activator) might also reduce the risk of infection in this population. When prescribing vitamin D supplements to these patients, however, their potential adverse effects, such as hypercalcemia leading to vessel calcification, should be considered.

As the global population is aging and kidney function declines with age, we foresee the population of people with chronic kidney disease to increase in the future. Not only does infection in patients with CKD induce poor outcomes in this population, requiring more healthcare consumption, but patients with CKD can also be a reservoir of multi-drug resistant organisms, disseminating resistant bacteria to other populations and thus contributing to worldwide antibiotic resistance. Global attention to infections in patients with CKD should thus be encouraged and prioritized.”

What are your plans for the future? Will you continue to conduct research in some way?

“I am planning to continue my clinical practice as a nephrologist and seeking opportunity to work as a post-doc at the same time. As a pioneer in using the electronic medical records in my home institution, Guangdong provincial hospital of Chinese medicine in China, I am interested in linking hospital data and regional administration database, performing epidemiology study and conducting pragmatic intervention study in healthcare setting.

As an increasing number of electronic medical records is generating big healthcare data in China, this could be a huge resource to identify factors that influence the prognosis of patients and investigate how to change the healthcare for a better health.”