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Incidence of infectious morbidity and mortality in dialysis patients
1Nephrology Unit, Department of Internal Medicine, University Hospital, Gent, Belgium. raymond.vanholder@rug.ac.be
Abstract:
Infections remain among the major causes of disease, hospitalization and death in uremic patients, especially in those treated by dialysis. Several pathophysiologic factors enhance this infectious risk: (1) breakdown of protective barriers; (2) affinity of bacteria for foreign materials; (3) bioincompatibility; (4) uremic toxin retention; (5) deficiency and resistance to vitamin D; (6) carriership of germs, and (7) malnutrition. Twenty to 30% of dialysis patients develop infection, and 20-30% of these die from their infection. Sepsis is significantly more frequent, and mortality secondary to sepsis is 50 times higher than in the normal population. Bacteremia (prevalence 1 episode/100 patient-months) is mainly caused by Gram-positive species, especially in vascular access-related infection and infection of unknown origin. Among these Gram-positive germs, staphylococci play a predominant role. The most frequent and most morbid viral infections are associated with hepatitis. Whereas the incidence of hepatitis B decreases, hepatitis C has become the major variant. The incidence of tuberculosis has increased up to 15 times, and in the Western world it mainly affects patients who immigrated from endemic areas. Fungal infections are also frequent, especially in the setting of peritoneal dialysis. In conclusion, infections remain a frequent and morbid problem in dialysis patients. Preventive measures should be applied more vigorously.
Insights
Dialysis patients face high infection risks due to several factors, leading to significant disease and death. Enhanced preventive measures are crucial to combat frequent and severe infections in this vulnerable population.
Area of Science:
- Nephrology
- Infectious Diseases
- Public Health
Background:
- Infections are a leading cause of morbidity and mortality in patients with uremia, particularly those undergoing dialysis.
- Dialysis patients exhibit an elevated susceptibility to infections due to multiple pathophysiologic factors, including compromised barriers, bioincompatibility, and malnutrition.
Purpose of the Study:
- To review the epidemiology and risk factors associated with infections in patients undergoing dialysis.
- To highlight the significant impact of infections, including sepsis and specific microbial pathogens, on dialysis patient outcomes.
Main Methods:
- Literature review and synthesis of existing data on infections in dialysis patients.
- Analysis of prevalence, causative agents, and mortality rates of various infections.
Main Results:
- Infections affect 20-30% of dialysis patients, with a 20-30% mortality rate among infected individuals.
- Sepsis is 50 times more common in dialysis patients than the general population. Gram-positive bacteria, particularly staphylococci, are the primary cause of bacteremia.
- Hepatitis C, tuberculosis, and fungal infections are significant concerns, with increasing incidence in certain populations.
Conclusions:
- Infections represent a frequent and serious clinical challenge for dialysis patients.
- There is a critical need for more rigorous implementation of preventive strategies to mitigate infection risks.