Characteristics of chronic kidney disease patients admitted to our hospital to investigate the cause of fever

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  • Sato Keitaro
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Otsubo Shigeru
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Sugi Orie
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Ogawa Mariko
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Sahara Yukako
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Iwasa Yuko
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Asamiya Yukari
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Kikuchi Kan
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Takei Takashi
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Ogawa Tetsuya
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Miwa Naoko
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Kimata Naoki
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Uchida Keiko
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Tsuchiya Ken
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University
  • Akiba Takashi
    Department of Blood Purification, Kidney Center, Tokyo Women's Medical University
  • Nitta Kosaku
    Department of Medicine, Kidney Cente, Tokyo Women's Medical University

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Other Title
  • 当院における原因不明の発熱で入院した慢性腎臓病患者の特徴
  • 当院[東京女子医科大学 第4内科]における原因不明の発熱で入院した慢性腎臓病患者の特徴
  • トウイン トウキョウ ジョシイカ ダイガク ダイ4 ナイカ ニ オケル ゲンイン フメイ ノ ハツネツ デ ニュウインシタ マンセイ ジンゾウビョウ カンジャ ノ トクチョウ

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Objective : The cause of fever in hemodialysis patients is sometimes difficult to diagnose. We investigated whether there were differences between the causes of fever in hemodialysis patients and non-hemodialysis chronic kidney disease (CKD) patients, which was not diagnosed in outpatient examinations or at another hospital. Materials and Methods : We conducted a retrospective chart review of 100 CKD patients who were admitted to our hospital to investigate the cause of fever between August 1998 and April 2007. We classified the patients according to CKD stage and compared the causes of their fever as determined by a thorough examination. Results : The cause of the fever was infection in 29 of the 42 hemodialysis patients, malignancy in 2, hemodialysis-related amyloidosis in 6, and drug-associated in 1, and the cause remained unknown in 4. None of their fevers was caused by collagen disease. On the other hand, the cause of the fever was infection in 39 of the 58 stage1 to 5 patients, collagen disease in 9, malignancy in 3, and drug-associated in 1, and it remained unknown in 6. Collagen disease was a less common cause of fever in hemodialysis patients than in the stage1 to 5 patients (0% versus 18.4%, p=0.0094). The duration of hemodialysis in patients with hemodialysis-related amyloidosis was 23.1±5.0 (16-29) years. Of the 29 patients in whom the cause of fever was infection, 2 were shown to have tuberculosis based in the results of Gaffky and/or culture and/or the polymerase chain reaction, but none of the other stage patients was found to have tuberculosis. Conclusion : Infection should be considered when investigating the cause of fever in hemodialysis patients, because it is the most frequent cause and because delayed treatment is associated with increased mortality. Tuberculosis and amyloidosis should also be considered.

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