Urinary tract infections (UTIs) and chronic kidney disease (CKD) contribute to a substantial global health issue that is closely intertwined. Research has demonstrated that CKD increases the likelihood of individuals experiencing frequent, severe, and often antibiotic-resistant UTIs, which can accelerate the diminution of kidney function and result in end-stage kidney disease. The inherent structural, metabolic, and immunological disruptions linked to CKD create a suitable environment for uropathogens to grow in the urinary tract. This risk is further heightened by ongoing exposure to antibiotics, which facilitates the emergence of multidrug-resistant (MDR) organisms, complicating treatment options. This review discusses the existing literature on the clinical and microbiological relationship between CKD and UTIs, particularly highlighting the increased vulnerability of CKD patients to MDR pathogens supported by recent studies. It also addresses the disparity in the burden of these conditions in lower-income countries where access to renal replacement therapies is limited, as illustrated by the ISN-Global Kidney Health Atlas analysis. This review emphasizes the bidirectional challenge presented by CKD, which increases the risk of significant UTIs, while UTIs can worsen kidney damage. This damaging cycle is further intensified by factors such as weakened immunity, microbiota, and rising antibiotic resistance, creating a substantial clinical issue. To effectively manage antibiotic treatment, it is necessary to transition toward a proactive, integrative strategy. Key components include early screening for CKD in high-risk populations, maintaining optimal urogenital hygiene, and implementing strong antibiotic stewardship to enhance treatment effectiveness. Additionally, this review explores promising non-antibiotic prophylactic methods, including vaccines, antimicrobial peptides, and lifestyle changes, which are critical for breaking the cycle of infection and renal decline. A comprehensive approach that incorporates preventive measures, judicious use of antimicrobials, and addressing underlying renal issues is essential for improving long-term outcomes in this vulnerable patient demographic.
Hamid et al. (Wed,) studied this question.