Increased risk of incident and recurrent urinary tract infection in autosomal dominant polycystic kidney disease: a contemporary propensity score-matched cohort study.

Urinary tract infection (UTI) is a clinically important complication of autosomal dominant polycystic kidney disease (ADPKD), often involving upper urinary tract and cyst infections. However, most epidemiologic data were generated decades ago, prior to contemporary advances in ADPKD management. We evaluated the current risk of incident and recurrent UTI in adults with ADPKD. Using the National Taiwan University Hospital Integrated Medical Database (2006-2021), adults with ADPKD were propensity score matched (1:4) to individuals without cystic kidney disease by age, sex, and chronic kidney disease (CKD) stage. Participants with prior UTI were excluded. Incident UTI was identified using validated International Classification of Disease codes. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) controlling for demographics, comorbidities, medications, and estimated glomerular filtration rate. Recurrent UTI (≥ 2 episodes) risk was assessed in sensitivity analyses. The cohort included 1,044 patients with ADPKD and 4,176 matched controls (mean follow-up 4.2 years). Incident UTI occurred in 17.9% of ADPKD patients and 15.6% of controls (45.96 vs. 36.24 per 1,000 patient-years). This represented an absolute difference of 2.3 percentage points. ADPKD was independently associated with increased incident UTI risk (aHR 1.20, 95% confidence internal (CI) 1.02-1.42). The association was more pronounced in males (aHR 1.59) and in CKD stages 3b-5 (aHR 1.51). ADPKD was also associated with recurrent UTI (incidence rate ratio 1.32, 95% CI 1.15-1.51). In the contemporary era, ADPKD remains independently associated with increased risk of incident and recurrent UTI, although the absolute increase in UTI incidence was moderate. Targeted surveillance and preventive strategies may be warranted in high-risk subgroups.