Infectious complications of the hemodialysis access

Area of Science:

• Nephrology
• Infectious Diseases
• Vascular Surgery

Background:

• Vascular access complications significantly contribute to morbidity and mortality in hemodialysis patients.
• Vascular access is implicated in 48-73% of hemodialysis bacteremias, with central venous catheters posing the highest infection risk.
• Prosthetic arteriovenous grafts, common in the US, are a known risk factor for infections, including silent infections in clotted grafts.

Purpose of the Study:

• To review the epidemiology and management of vascular access-related infections in hemodialysis patients.
• To highlight the role of staphylococcal organisms in these infections and their associated complications.
• To discuss strategies for prevention and management, emphasizing vascular access type and antibiotic therapy.

Main Methods:

• Literature review of studies on vascular access infections in hemodialysis.
• Analysis of infection rates associated with different vascular access types (fistulas, grafts, catheters).
• Discussion of current and emerging approaches to infection management and prevention.

Main Results:

• Native arteriovenous fistulas have the lowest infection risk; central venous catheters have the highest.
• Staphylococcal infections are frequent, leading to high mortality, recurrence, and metastatic issues.
• Silent infections in prosthetic grafts are an under-recognized cause of bacteremia.

Conclusions:

• Effective management requires concurrent antibiotic therapy and vascular access care, prioritizing native access preservation.
• Preventive strategies should focus on increasing arteriovenous fistula placement and minimizing catheter use.
• Vigilant monitoring of vascular access is crucial for early detection and treatment of infections.