# Adverse dengue outcomes in patients with chronic kidney disease: A population-based analysis of 5.8 million individuals from Brazil

## TL;DR

People with chronic kidney disease in Brazil are at much higher risk of severe dengue outcomes, including hospitalization and death.

## Contribution

This is the first national-level study showing that chronic kidney disease significantly increases dengue severity and mortality in Brazil.

## Key findings

- Patients with CKD had 3.09 times higher odds of death from dengue compared to those without CKD.
- CKD was independently associated with increased hospitalization and severe dengue outcomes.
- Early recognition and targeted care for CKD patients with dengue are critical to reduce mortality.

## Abstract

Dengue fever poses a major public health threat in Brazil, particularly among individuals with comorbid conditions. Chronic kidney disease (CKD) is known to impair immune defenses and may predispose patients to worse infectious outcomes, but its impact on dengue has not been comprehensively evaluated at the national level. This study aimed to assess the association between CKD and adverse clinical outcomes of dengue fever.

We conducted a population-based analysis using 2024 data from the Brazilian Information System for Notifiable Diseases (SINAN). Patients with a confirmed diagnosis of dengue, based on laboratory or clinical-epidemiological criteria, were included in the study. The cohort was stratified based on their CKD status. Clinical features and outcomes (hospitalization, severe dengue, and death) were compared. Multivariable logistic regression models weighted by inverse probability of treatment weighting (IPTW) were used to estimate adjusted odds ratios (ORs).

Among 5,837,904 confirmed dengue cases, 30,527 (0.5%) had CKD. Compared to patients without CKD, those with CKD had significantly higher rates of hospitalization (14% vs. 4%), severe dengue (1.6% vs. 0.1%), and death (2.2% vs. 0.1%) (all p < 0.001). In adjusted analyses, CKD was independently associated with increased odds of death (OR = 3.09, 95% CI: 2.66–3.59) and the composite outcome (OR = 1.62, 95% CI: 1.53–1.71). Hematologic and autoimmune comorbidities also conferred increased risk.

CKD significantly worsens clinical outcomes in dengue fever. These findings highlight the need for early recognition, tailored care, and targeted public health strategies to protect this high-risk population during dengue outbreaks.

Dengue affects millions of people in Brazil every year, but not everyone faces the same risk of severe illness. We asked a simple question with big public-health consequences: do people living with chronic kidney disease have worse outcomes when they get dengue? To answer it, we examined Brazil’s national notifiable-disease records for all confirmed dengue cases in 2024. We compared those with and without chronic kidney disease and accounted for differences such as age and other health problems. We found a clear pattern. People with chronic kidney disease were hospitalized more often, progressed to severe dengue more often, and had a markedly higher risk of death, about three times higher, than those without kidney disease. Warning signs that indicate possible complications were also more frequent in this group. These findings matter for everyday care and for planning during outbreaks. They support prioritizing people with chronic kidney disease for early evaluation, careful fluid management, and timely referral. They also strengthen the case for including this group among those prioritized for dengue vaccination in endemic areas. Our study provides national-level evidence to help clinicians and health authorities protect a highly vulnerable population.