Advertisement
ADVANCED SEARCH

This Article Figures Only Full Text Full Text (PDF) [Abridged Version] All Versions of this Article: cmaj.050581v1 cmaj.050581v2 173/3/261    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Garg, A. X. Search for Related Content PubMed PubMed Citation Articles by Garg, A. X. Related Collections Hypertension Other public health Infection Nephrology

Risk of hypertension and reduced kidney function after acute gastroenteritis from bacteria-contaminated drinking water

From the Division of Nephrology (Garg, Moist, Thiessen-Philbrook, Suri, Clark), the Department of Epidemiology and Biostatistics (Garg, Moist) and the Department of Pediatrics (Salvadori), University of Western Ontario, London, Ont.; the Department of Pediatrics, University of British Columbia, Vancouver, BC (Matsell); the Departments of Clinical Epidemiology and Biostatistics and of Medicine, McMaster University, Hamilton, Ont. (Garg, Haynes); and the Department of Medicine, University of Toronto, Toronto, Ont. (Ray)Walkerton Health Study Investigators: William F. Clark, Amit X. Garg, Jennifer Macnab, Jeff Mahon, Louise Moist, Janet Pope, Patricia Rosas-Arellano, Rita S. Suri and Heather R. Thiessen-Philbrook, Department of Medicine, University of Western Ontario, London, Ont.; John Howard and Marina Salvadori, Department of Pediatrics, University of Western Ontario, London, Ont.; Steve Collins, R. Brian Haynes and John Marshall, Department of Medicine, McMaster University, Hamilton, Ont.; Douglas Matsell, Department of Pediatrics, University of British Columbia, Vancouver, BC; and Joel Ray, Department of Medicine, University of Toronto, Toronto, Ont.

Correspondence to: Dr. Amit X. Garg, London Kidney Clinical Research Unit, Rm. A01, Westminster Tower, London Health Sciences Centre, 800 Commissioners Rd. E, London ON N6A 4G5; fax 519 685-8072; amit.garg{at}lhsc.on.ca

Background: The long-term health consequences of acute bacterial gastroenteritis remain uncertain. We studied the risk of hypertension and reduced kidney function after an outbreak of acute gastroenteritis due to contamination of a regional drinking water supply with Escherichia coli O157:H7 and Campylobacter species.

Methods: A total of 1958 adults with no known history of hypertension or kidney disease before the outbreak participated in a long-term follow-up study. Of the participants, 675 had been asymptomatic during the outbreak, 909 had had moderate symptoms of acute self-limited gastroenteritis, and 374 had had severe symptoms that necessitated medical attention. The outcomes of interest were a diagnosis of hypertension or the presence of reduced kidney function and albuminuria during the follow-up period.

Results: After a mean follow-up of 3.7 years after the outbreak, hypertension was diagnosed in 27.0% of participants who had been asymptomatic during the outbreak and in 32.3% and 35.9% of those who had had moderate and severe symptoms of acute gastroenteritis respectively (trend p = 0.009). Compared with the asymptomatic participants, those with moderate and severe symptoms of gastroenteritis had an adjusted relative risk of hypertension of 1.15 (95% confidence interval [CI] 0.97–1.35) and 1.28 (95% CI 1.04–1.56) respectively. A similar graded association was seen for reduced kidney function, defined as the presence of an estimated glomerular filtration rate below 60 mL/min per 1.73 m² (trend p = 0.03). No association was observed between gastroenteritis and the subsequent risk of albuminuria.

Interpretation: Acute bacterial gastroenteritis necessitating medical attention was associated with an increased risk of hypertension and reduced kidney function 4 years after infection. Maintaining safe drinking water remains essential to human health, as transient bacterial contaminations may have implications well beyond a period of acute self-limited illness.

This article has been cited by other articles:

				K. G.J. Pollock, E. Duncan, and J. M. Cowden Emotional and Behavioral Changes in Parents of Children Affected by Hemolytic-Uremic Syndrome Associated With Verocytotoxin-Producing Escherichia Coli: A Qualitative Analysis Psychosomatics, May 1, 2009; 50(3): 263 - 269. [Abstract] [Full Text] [PDF]

				M. Salvadori, J. M. Sontrop, A. X. Garg, J. Truong, R. S. Suri, F. H. Mahmud, J. J. Macnab, and W. F. Clark Elevated Blood Pressure in Relation to Overweight and Obesity Among Children in a Rural Canadian Community Pediatrics, October 1, 2008; 122(4): e821 - e827. [Abstract] [Full Text] [PDF]

				A. X. Garg, J. E. Pope, H. Thiessen-Philbrook, W. F. Clark, J. Ouimet, and on behalf of the Walkerton Health Study Investigat Arthritis risk after acute bacterial gastroenteritis Rheumatology, February 1, 2008; 47(2): 200 - 204. [Abstract] [Full Text] [PDF]

				W. F. Clark, J. J. Macnab, S. J. Chen, R. Suri, L. Moist, and A. X. Garg Evaluation of GFR Estimating Equations in the General Community: Implications for Screening Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 787 - 795. [Abstract] [Full Text] [PDF]

HOME	CURRENT ISSUE	PAST ISSUES	COLLECTIONS	HELP	SEARCH
Copyright 1995-2005, Canadian Medical Association. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p) All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.