Theme: Epidemiology & Public Health Research Year: 2024
Background: People who inject drugs (PWID) may be at an elevated risk of proteinuria and chronic kidney disease (CKD). AA (inflammatory) amyloidosis is a rare cause of proteinuria and progressive renal insufficiency in PWID, especially those with chronic or repeated skin/soft tissue infections. With rising reports of severe wounds in PWID, we chose to find out if cases of amyloidosis or proteinuric CKD have also increased.
Methods: We surveyed 2800 Infectious Diseases Physicians through a provider-based sentinel network established by the CDC querying if members who took care of PWID noted changes/increase in severity of wounds and increase diagnoses of amyloidosis or proteinuric CKD Based on these results the authors ran a query on TriNetX which is a global federated health research network of electronic medical records across large healthcare organizations (HCOs) looking for trends of diagnoses of chronic kidney disease or proteinuria among people with ICD10 diagnosis codes which are used for PWID.
Results: Survey responses were were higher from states where AA amyloidosis in PWID has been reported (CA, WA) or where xylazine associated wounds/overdoses have been increasingly identified. 36% and 20% of respondents noted an increase in severe wounds and an increase in limb amputations in PWID respectively. 27% and 9% respondents had seen proteinuric CKD and amyloidosis in PWID respectively.
Analysis of EMR data noted rise in incidence of diagnoses of proteinuria or CKD3 or higher among PWID from 0.17% in 2016 to 0.58% in 2023. Incidence ratio of amyloidosis rose from 62 cases (0.006%) in 2016 to 133 cases (0.015%) in 2022. Incidence of extremity amputation rose from 0.037%( 367 cases) in 2016 to 0.093% (589 cases) in 2023.
Conclusion: Experiences of ID physicians who care for PWID are corroborated by longitudinal EMR data indicating rising trend of severw wounds, proteinuric CKD and amyloidosis in PWID.
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