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Background <p>Patients receiving maintenance hemodialysis (MHD) have a markedly increased incidence of urinary tract infection (UTI) because of impaired immune function, reduced urine output, and complications related to medical procedures. Post-void residual urine volume (PVR) is a key indicator of bladder emptying function. Elevated PVR is associated with urinary retention and bacterial colonization and is considered an indicator related to higher UTI risk. However, previous studies have mainly examined the cross-sectional association between a single PVR measurement and UTI risk. In patients receiving MHD, PVR often changes dynamically because of autonomic neuropathy, diabetic cystopathy, and fluctuations in volume status; therefore, a single assessment may not fully capture longitudinal changes. Group-based trajectory modeling (GBTM) can identify distinct longitudinal patterns, but evidence regarding its use to characterize PVR trajectories in the MHD population and assess their association with UTI risk remains limited.</p> Methods <p>Clinical data were retrospectively collected from 302 patients who received regular MHD treatment at our hospital from January 2021 to December 2024. PVR was measured by ultrasonography every 3–6 months. GBTM was applied to repeated PVR measurements to identify trajectory classes. The optimal model was selected according to the Bayesian information criterion (BIC), average posterior probability (APP), odds of correct classification (OCC), and clinical interpretability. Baseline characteristics and UTI occurrence were compared among trajectory groups, and baseline characteristics of included and excluded patients were compared. Kaplan-Meier analysis and the log-rank test were used to compare cumulative UTI incidence. Posterior-probability-weighted Cox proportional hazards regression and Fine-Gray competing-risk models with death as a competing event were used to assess the association between PVR trajectories and UTI risk. In an exploratory analysis, death and nonfatal study-exit events were also combined as competing events. Restricted cubic spline (RCS) regression was used to explore the dose-response association between baseline PVR and first UTI risk. Robustness was evaluated using a clinically parsimonious Cox model, Firth penalized partial-likelihood Cox regression, and other sensitivity analyses.</p> Results <p>GBTM identified three PVR trajectories: low-level stable (138 patients, 45.7%), moderate-level increasing (103 patients, 34.1%), and persistently elevated (61 patients, 20.2%). During a median follow-up of 26.8 months, 60 patients (19.9%) developed a first UTI. The proportions of UTI in the low-level stable, moderate-level increasing, and persistently elevated groups were 10.1%, 22.3%, and 37.7%, respectively (<i>χ²</i>=20.78, <i>P</i> &lt; 0.001). In the fully adjusted Cox model, the moderate-level increasing group showed a borderline association with higher first UTI risk (hazard ratio [HR] = 1.96, 95% confidence interval (CI): 1.01–3.82, <i>P</i> = 0.047), but this association did not reach statistical significance in the Fine-Gray competing-risk model (subdistribution hazard ratio [SHR] = 1.85, 95% CI: 0.94–3.64, <i>P</i> = 0.073). The persistently elevated group was independently associated with higher first UTI risk in both the Cox model (HR = 3.35, 95% CI: 1.68–6.68, <i>P</i> = 0.001) and the Fine-Gray model (SHR = 3.12, 95% CI: 1.53–6.36, <i>P</i> = 0.002). RCS exploratory analysis suggested a nonlinear association between baseline PVR and first UTI risk (overall association test <i>P</i> &lt; 0.001; nonlinearity test <i>P</i> = 0.012); the slope of the HR curve tended to increase around approximately 80 mL, and this value was used to describe an exploratory curve feature in this study sample.</p> Conclusion <p>Among MHD patients with measurable urine output who were able to complete serial PVR assessment, a persistently elevated PVR trajectory was independently associated with higher first UTI risk, and baseline PVR showed a nonlinear dose-response association with first UTI risk. Serial PVR assessment may provide supplementary risk-stratification information for MHD patients with measurable urine output.</p> Clinical trial registration <p>Not applicable.</p>

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Association between post-void residual urine volume trajectories and incident urinary tract infection in patients receiving maintenance hemodialysis

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  • 发表日期：

    2026年6月27日

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  • Wen-Jing Yan,
  • Yi-Na Wang,
  • Ying Zheng,
  • Jin-Feng Xue

摘要

Background

Patients receiving maintenance hemodialysis (MHD) have a markedly increased incidence of urinary tract infection (UTI) because of impaired immune function, reduced urine output, and complications related to medical procedures. Post-void residual urine volume (PVR) is a key indicator of bladder emptying function. Elevated PVR is associated with urinary retention and bacterial colonization and is considered an indicator related to higher UTI risk. However, previous studies have mainly examined the cross-sectional association between a single PVR measurement and UTI risk. In patients receiving MHD, PVR often changes dynamically because of autonomic neuropathy, diabetic cystopathy, and fluctuations in volume status; therefore, a single assessment may not fully capture longitudinal changes. Group-based trajectory modeling (GBTM) can identify distinct longitudinal patterns, but evidence regarding its use to characterize PVR trajectories in the MHD population and assess their association with UTI risk remains limited.

Methods

Clinical data were retrospectively collected from 302 patients who received regular MHD treatment at our hospital from January 2021 to December 2024. PVR was measured by ultrasonography every 3–6 months. GBTM was applied to repeated PVR measurements to identify trajectory classes. The optimal model was selected according to the Bayesian information criterion (BIC), average posterior probability (APP), odds of correct classification (OCC), and clinical interpretability. Baseline characteristics and UTI occurrence were compared among trajectory groups, and baseline characteristics of included and excluded patients were compared. Kaplan-Meier analysis and the log-rank test were used to compare cumulative UTI incidence. Posterior-probability-weighted Cox proportional hazards regression and Fine-Gray competing-risk models with death as a competing event were used to assess the association between PVR trajectories and UTI risk. In an exploratory analysis, death and nonfatal study-exit events were also combined as competing events. Restricted cubic spline (RCS) regression was used to explore the dose-response association between baseline PVR and first UTI risk. Robustness was evaluated using a clinically parsimonious Cox model, Firth penalized partial-likelihood Cox regression, and other sensitivity analyses.

Results

GBTM identified three PVR trajectories: low-level stable (138 patients, 45.7%), moderate-level increasing (103 patients, 34.1%), and persistently elevated (61 patients, 20.2%). During a median follow-up of 26.8 months, 60 patients (19.9%) developed a first UTI. The proportions of UTI in the low-level stable, moderate-level increasing, and persistently elevated groups were 10.1%, 22.3%, and 37.7%, respectively (χ²=20.78, P < 0.001). In the fully adjusted Cox model, the moderate-level increasing group showed a borderline association with higher first UTI risk (hazard ratio [HR] = 1.96, 95% confidence interval (CI): 1.01–3.82, P = 0.047), but this association did not reach statistical significance in the Fine-Gray competing-risk model (subdistribution hazard ratio [SHR] = 1.85, 95% CI: 0.94–3.64, P = 0.073). The persistently elevated group was independently associated with higher first UTI risk in both the Cox model (HR = 3.35, 95% CI: 1.68–6.68, P = 0.001) and the Fine-Gray model (SHR = 3.12, 95% CI: 1.53–6.36, P = 0.002). RCS exploratory analysis suggested a nonlinear association between baseline PVR and first UTI risk (overall association test P < 0.001; nonlinearity test P = 0.012); the slope of the HR curve tended to increase around approximately 80 mL, and this value was used to describe an exploratory curve feature in this study sample.

Conclusion

Among MHD patients with measurable urine output who were able to complete serial PVR assessment, a persistently elevated PVR trajectory was independently associated with higher first UTI risk, and baseline PVR showed a nonlinear dose-response association with first UTI risk. Serial PVR assessment may provide supplementary risk-stratification information for MHD patients with measurable urine output.

Clinical trial registration

Not applicable.