Sepsis in hemodialysis patients

Abstract

BackgroundBacterial infections are very common in End Stage Renal Disease (ESRD) patients. The diagnosis of sepsis in such patients is often challenging and requires a high index of suspicion. The aim of this study is to report on a series of patient with ESRD on hemodialysis (HD) diagnosed with sepsis.MethodsSingle center retrospective study looking at ESRD on HD who presented to our tertiary hospital were retrieved. Inclusion criteria included a discharge diagnosis of sepsis, septic shock or bacteremia.ResultsOur sample was composed of 41 females and 49 males, with a mean age of 70 ± 15 years. Infections from the HD catheters followed by lower respiratory tract infections were the most common cause of bacteremia. IV fluid replacement for the first 6 and 24 h were 0.58 and 1.27 l respectively. Vasopressors were used in 30 patients with norepinephrine, dopamine and dobutamine used in 22, nine and one patients respectively. Out of 90 subjects, 24 (26.6 %) were dead within the same hospital visit. the 28 days out of hospital mortality was 25.6 %. There was no significant difference in mortality in patients who presented with less than two SIRS or two or more SIRS criteria.ConclusionThis is the first study looking at an in depth analysis of sepsis in the specific dialysis population and examining the influence of fluid resuscitation, role of SIRS criteria and vasopressor use on their mortality.

Important Bacterial and Viral Infections in Patients with Hemodialysis

“…Infection has become a main reason of morbidity and is the second most common reason of death in the patients with HD (2). At the moment, Staphylococcus aureus is the most important isolated pathogen causing infection in such patients (2).…”

“…Hemodialysis patients with arteriovenous fistula (AVF) have a significantly lower death rate than patients with dialysis catheter, which is related to immune activation (2,3).…”

“…At the moment, Staphylococcus aureus is the most important isolated pathogen causing infection in such patients (2). These patients are affected by staphylococcal infections due to their low immune activation, multiple needle punctures and skin colonization (2).…”

“…Most of the infections are caused by Escherichia coli, followed by Staphylococcus coagulase negative in mix infections (2,3).…”

“…These risk factors include the use of a central venous catheter (CVC), having diabetes mellitus, hypoalbuminemia, and anemia, and female gender. Also, colonization by methicillin-resistant Staphylococcus aureus (MRSA) is effective in this process (2).…”