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Risk factors for cytomegalovirus reactivation in patients with kidney disease under immunosuppressive therapy

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Abstract

Background

Cytomegalovirus (CMV) is a herpes virus that causes latent infections, and its reactivation due to immunosuppression can cause fatal complications. CMV reactivation is a complication frequently occurring in patients with kidney disease who require immunosuppressive therapy, and, therefore, this study retrospectively examined its risk factors.

Methods

Patients who received immunosuppressive therapy and underwent the CMV antigenemia test (CMV antigenemia: C7-HRP) for the treatment of primary nephritis (minimal change disease, membranous nephropathy, membranoproliferative glomerulonephritis, focal glomerulosclerosis, and IgA nephropathy) and anti-neutrophil cytoplasmic autoantibody (ANCA)-associated nephritis diagnosed at Saiseikai Kurihashi Hospital from January 2014 to December 2019 were recruited as study participants. Risk factors of CMV reactivation were examined using univariable and multivariable analyses.

Results

Among the 64 patients (36 men and 28 women; median age, 72 years) included, 34 had primary nephritis (20 minimal disease changes, 10 membranous nephropathy, 1 membranoproliferative glomerulonephritis, 1 focal glomerulosclerosis, and 2 IgA nephropathy) and 30 had ANCA-associated nephritis. Regarding glucocorticoid (GC), 43 patients received oral GC therapy, whereas 21 received GC pulse therapy. CMV reactivation participants showed significant differences in age, ANCA-associated nephritis, hemoglobin level, lymphocyte count, maximum GC dosage, and hemodialysis in univariable analysis. Multivariate analysis showed significantly lower lymphocyte counts in CMV-reactivated patients, but no significant difference in other factors.

Conclusion

In patients with kidney disease, who require immunosuppressive therapy, CMV reactivation risk is high in patients with low lymphocyte count, and monitoring CMV during the treatment course could lead to early diagnosis and treatment of CMV disease.

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Acknowledgements

We thank the staff members at the institute of Nephrology of Saiseikai Kurihashi Hospital for their effort and collaboration.

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Authors and Affiliations

  1. Department of Nephrology, Saitama-ken Saiseikai Kurihashi Hospital, Kuki-shi, Saitama-ken, 349-1105, Japan

    Yosuke Iwatani, Nobuyuki Amemiya, Hirohiko Nokiba, Mayuko Yamazaki & Hidekazu Sugiura

  2. Department of Nephrology, Tokyo Women’s Medical University, Tokyo, 162-0054, Japan

    Yosuke Iwatani, Nobuyuki Amemiya, Hirohiko Nokiba, Mayuko Yamazaki, Hidekazu Sugiura & Kosaku Nitta

Authors
  1. Yosuke Iwatani
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  2. Nobuyuki Amemiya
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  3. Hirohiko Nokiba
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  5. Hidekazu Sugiura
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  6. Kosaku Nitta
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Correspondence to Yosuke Iwatani.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 78–1) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Iwatani, Y., Amemiya, N., Nokiba, H. et al. Risk factors for cytomegalovirus reactivation in patients with kidney disease under immunosuppressive therapy. Clin Exp Nephrol 26, 22–28 (2022). https://doi.org/10.1007/s10157-021-02117-5

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  • DOI: https://doi.org/10.1007/s10157-021-02117-5

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