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Updated: Jan 12, 2026
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Infective endocarditis in chronic haemodialysis patients: an increasing clinical challenge
Gaetano Nucifora1, Luigi P Badano, Pierluigi Viale
1Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria di Udine, P.le S. Maria della Misericordia, 15, 33100 Udine, Italy. gnucifora@cardionet.it
Insights
Infective endocarditis (IE) is a serious risk for chronic haemodialysis (HD) patients, leading to high mortality. This review clarifies unique features, diagnosis, and treatment for HD-associated IE.
Area of Science:
- Nephrology
- Cardiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) presents higher morbidity and mortality in chronic haemodialysis (HD) patients compared to the general population.
- IE in HD patients is a leading cause of death, second only to cardiovascular disease.
- A new category, health-care associated and HD-associated IE, is proposed due to patient peculiarities.
Purpose of the Study:
- To review the unique characteristics of IE in chronic HD patients.
- To clarify pathogenesis, diagnosis, therapeutic options, and prognostic determinants of IE in this population.
Main Methods:
- Literature review focusing on IE in chronic HD patients.
- Analysis of diagnostic challenges and therapeutic strategies.
- Evaluation of prognostic factors specific to HD patients.
Main Results:
- Chronic HD patients face increased IE risk due to factors like age and valvular calcification.
- Specialized cardiac, diagnostic, echocardiographic, and surgical expertise is crucial.
- The incidence of IE in HD patients is expected to rise.
Conclusions:
- IE in chronic HD patients requires tailored diagnostic and therapeutic approaches.
- Understanding the peculiar features of HD-associated IE is vital for improved patient outcomes.
- Multidisciplinary expertise is essential for managing this complex condition.
Abstract:
Infective endocarditis (IE) in chronic haemodialysis (HD) is significantly more common and causes greater morbidity and mortality than in the general population, being second only to cardiovascular disease as the leading cause of death in this group of patients. Because of the peculiarity of this group of patients, it has been recently proposed to add a fifth category (health-care associated and HD-associated IE) in the actually four categories classification of IE (namely, native valve IE, prosthetic valve IE, IE in e.v. drug users, and nosocomial IE). Given that rates of acceptance into HD are increasing (including a higher proportion of older patients in whom valvular calcification is virtually ubiquitous), and along with improved survival in HD patients, the incidence of IE in this subset of patients will probably increase with significant diagnostic and therapeutic implications. In particular cardiac, diagnostic, echocardiographic, and surgical expertises are required to correctly identify patients at higher risk and who may benefit from surgical treatment. The aim of this review is to clarify the peculiar features of chronic HD patients with regard to pathogenesis, diagnosis, current therapeutic options, and determinants of prognosis of IE.
