Infections in Patients with Chronic Kidney Disease
Section snippets
Uremia and susceptibility to infection
Although less well-remarked in the general medical literature, a predisposition to infection seems to be a cardinal feature of advanced kidney disease. For example, postmortem findings in many of the cases described by Bright [5] showed that inflammatory pneumonitis, acute bronchitis, and peritonitis were prominent, suggesting that infection may have contributed to the demise of these unfortunate patients. Advanced uremia has long been considered to be a state of immune hyporesponsiveness. For
Infectious mortality in dialysis populations
Bacterial infection has declined as a cause of death in many countries. For example, the crude death rate in the United States was 841.9 per 100,000 in 2003 [13]. Cardiac diseases were the number one reported cause of death, accounting for 28% of deaths, followed by malignant neoplasms (22.7%) and cerebrovascular disease (6.4%). The combined category of influenza and pneumonia (2.7%) was ranked seventh and septicemia (1.4%) was ranked tenth. In patients with end-stage renal disease during the
Septicemia in dialysis patients
Survival expectations in maintenance populations are guarded. It is generally believed that much of this excess mortality is caused by cardiovascular disease, and research into the problem of cardiovascular disease in chronic kidney disease populations has accelerated considerably over time. Fig. 1 documents noteworthy growth in citation rates for cardiovascular disease in dialysis subjects and minimal growth in citation rates for septicemia. When the search strategy “dialysis (cardiac or heart
Pneumonia in dialysis patients
As with septicemia, reliable epidemiologic information about pneumonia in dialysis populations is scanty, even though it has been known for several years that mortality rates from pulmonary infections are almost 20 times higher than in the general population, even when differences in age, gender, race, and diabetes prevalence are taken into account [22]. The United States Renal Data System typically reports that pneumonia accounts for hospitalization rates of 80 to 100 per hundred patient-years
Associations between major bacterial infections, inflammation, and cardiovascular disease
Pathophysiologic and numerical reasoning both suggest that major bacterial infections, like pneumonia and septicemia, could be responsible for a nontrivial amount of the massive cardiovascular mortality rates seen in dialysis populations. The United States nationwide study, cited previously, tested the hypothesis that the development of septicemia was an intermediate step in the development of cardiovascular disease in dialysis patients, using a segmented time-dependent Poisson regression model
Prevention of infections in patients with chronic kidney disease
Regardless of age and the presence of other comorbid illnesses, it is recommended that patients with chronic kidney disease receive annual influenza vaccination and a single vaccination against Pneumococcus, which should be readministered after 5 years [37]. Observational data suggest that the implementation of these recommendations is suboptimal in populations with advanced chronic kidney disease. For example, one study examined US Medicare reimbursement claims data in the 2-year period before
Prevention of peritonitis in peritoneal dialysis patients
Although worldwide rates continue to fall, peritonitis remains the leading cause of technique failure and still represents a major risk factor for mortality in peritoneal dialysis patients [56], [57]. International guidelines for the treatment of peritonitis have been published [58]; detailed treatment algorithms for overt peritonitis are not described in this document and this section concentrates on potentially preventive strategies.
Most cases of peritonitis are caused by contamination with
Summary
The clinical epidemiology, prevention, and treatment of major infections in patients with chronic kidney disease have yet to be addressed systematically and most of the information has come from dialysis populations. In reality, although it has been conservatively estimated that at least 5% of the general population has serious renal dysfunction, most of this subpopulation is at risk from premature cardiovascular disease, and not end-stage renal disease [73]. Conceptually, it is easy to
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Cited by (21)
CKD and Risk of Hospitalization and Death With Pneumonia
2009, American Journal of Kidney DiseasesCitation Excerpt :Other explanations, such as increased complications or poorer responses to treatment, may account for more frequent hospitalization or death after pneumonia in patients with CKD. Alternatively, mechanisms believed to contribute to the increased susceptibility to infection observed in patients with end-stage renal disease may begin with milder decreases in eGFR and worsen as CKD progresses.18,22,23 The increased relative risk of pneumonia at lower eGFRs was more pronounced in younger patients.
Prosthetic Infection: Lessons from Treatment of the Infected Vascular Graft
2009, Surgical Clinics of North AmericaCitation Excerpt :Continued use of the same access site completes the argument for partial graft excision over complete excision. Hemodialysis access prosthetics represent an added challenge to vascular surgeons because of the continual risk of inoculation of the graft during scheduled hemodialysis and the immune hyporesponsiveness of the uremic state.42 Increased colonization with phagocytic bacteria, particularly S aureus, breakdown of innate immunity, aberrant acquired immunity, and the regular need to access the graft put uremic, hemodialysis patients at a greater increased risk of graft infection.37
Antimicrobial activity of daptomycin and selected comparators tested against bloodstream Staphylococcus aureus isolates from hemodialysis patients
2009, International Journal of Infectious DiseasesCitation Excerpt :Patients on long-term hemodialysis are at a significantly higher risk for catheter-related bloodstream infections (BSI). Infection, mainly septicemia, is second to cardiovascular disease as the leading cause of death in patients with end-stage renal disease (ESRD) in the USA.1–3 In fact, catheters account for a significant proportion of septicemia in this population.
Risk of bloodstream infection in patients with renal dysfunction: A population-based cohort study
2020, Epidemiology and Infection