{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:47:52Z","timestamp":1785836872929,"version":"3.56.0"},"reference-count":35,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["20202640-0022937"],"award-info":[{"award-number":["20202640-0022937"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and hypothesis<\/jats:title>\n                    <jats:p>Dengue fever and chronic kidney disease (CKD) are growing health concerns. However, the features and indicators of severe dengue (SD) in CKD patients remain poorly understood. This study aimed to describe dengue in CKD patients, test the relationship between CKD and SD and identify indicators of SD during the 2019 dengue epidemic in La R\u00e9union Island, a region with high prevalence of metabolic diseases and dengue transmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study was conducted on patients aged\u00a0\u226515 years with dengue who presented to the University Hospital of La R\u00e9union between January and June 2019. CKD was defined according to Kidney Disease: Improving Global Outcomes criteria. Clinical, biological, and outcome data were extracted from the EPIDENGUE database. We used nonconditional logistic regression models to identify dengue-specific indicators in CKD patients and indicators of SD [World Health Organization (WHO)-2009 definition] and conditional models to assess the relationship between CKD and SD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1498 confirmed dengue cases, 105 (7%) had CKD. CKD patients were older (median age 77\u00a0vs 51 years) with more comorbidities, especially diabetes and hypertension. They displayed a distinct dengue phenotype, with fewer classic symptoms (myalgia and rash) but more dyspnea, encephalopathy, anemia, inflammation, and neutrophil-to-platelet ratios. CKD patients were more likely to develop SD (46%\u00a0vs 18%, P &amp;lt;\u00a0.001; conditional odds ratio 1.93; 95% confidence interval 1.21\u20133.06) and mortality (6.7%\u00a0vs 1.6%). Severe renal involvement was the main driver of severity. WHO warning signs were poor indicators of SD in CKD patients. In multivariate analysis, insulin-treated diabetes, afebrile presentation, and early cardiorespiratory involvement indicated SD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CKD alters the presentation and worsens the prognosis of dengue independently of confounders. Classical warning signs are insufficient in predicting SD among CKD patients. Diabetes, afebrile presentation, and early cardiorespiratory symptoms require closer monitoring and early hospitalization. CKD patients are a high-risk group needing tailored diagnostic and preventive strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfag151","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:56:20Z","timestamp":1783511780000},"source":"Crossref","is-referenced-by-count":0,"title":["Atypical presentation and severity of dengue fever in patients with CKD"],"prefix":"10.1093","author":[{"given":"Mamitiana","family":"Randriamanana","sequence":"first","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation , CHU Felix Guyon, Saint-Denis, La Reunion ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves-Marie","family":"Diarra","sequence":"additional","affiliation":[{"name":"INSERM, CIC 1410, Centre Hospitalier Universitaire R\u00e9union , Saint-Pierre, La R\u00e9union 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Centre Hospitalier Universitaire R\u00e9union , Saint-Pierre, La R\u00e9union ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Julien","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation , CHU Felix Guyon, Saint-Denis, La Reunion ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Charroyer","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Kidney Transplantation , CHU Felix Guyon, Saint-Denis, La Reunion ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-5919","authenticated-orcid":false,"given":"Patrick","family":"G\u00e9rardin","sequence":"additional","affiliation":[{"name":"INSERM, CIC 1410, Centre Hospitalier Universitaire R\u00e9union , Saint-Pierre, La R\u00e9union 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