Clin Exp Nephrol. 2026 Apr 13. doi: 10.1007/s10157-026-02868-z. Online ahead of print.
ABSTRACT
BACKGROUND: Glucocorticoids have diverse adverse effects, particularly infections that may be severe or opportunistic. Therefore, glucocorticoids are often initiated during hospitalization; however, the optimal glucocorticoid dose at discharge remains uncertain. This study examined whether the discharge dose of glucocorticoids influences infection onset and rehospitalization in patients with renal disease.
METHODS: This was a multicenter retrospective cohort study conducted at eight hospitals from 2013 to 2023. Adults initiated on oral prednisolone ≥ 30 mg/day during hospitalization for renal disease were included. The primary outcome was infection within 30 days of discharge; secondary outcomes were rehospitalization for infection and unplanned rehospitalization for any cause. Logistic regression analyses were performed to evaluate primary and secondary outcomes, using glucocorticoid dose and other potential confounding factors as explanatory variables.
RESULTS: Among 684 patients, 24 (3.5%) developed infections within 30 days, including 17 bacterial (11 pneumonia), 5 fungal, and 2 cytomegalovirus infections; 17 patients (2.5%) required rehospitalization for infection. Overall, 51 patients (7.4%) had unplanned rehospitalization, most often for edema control, primary-disease relapse, or dehydration/electrolyte imbalance. In multivariate logistic regression analysis, oral glucocorticoid dose at discharge was not significantly associated with the primary outcome. No significant differences in infection onset or rehospitalization outcomes were observed across categories of oral glucocorticoid dose at discharge, and similar results were obtained regardless of the cutoff values or categorization strategy used.
CONCLUSION: Higher discharge doses of oral glucocorticoids did not increase infection or rehospitalization rates. Discharge timing should therefore be individualized based on overall patient risk rather than glucocorticoid dose alone.
PMID:41973359 | DOI:10.1007/s10157-026-02868-z