Risk factors and treatment of pyelonephritis requiring hemodialysis: A PRISMA-guided systematic review

The present study aims to identify risk factors and evaluate treatment approaches in adult patients diagnosed with pyelonephritis requiring hemodialysis.

A comprehensive literature search was conducted using various electronic databases, published between 2004 and 2024. Totally, 24 articles reporting adult patients diagnosed with pyelonephritis who underwent hemodialysis were included. Risk factors and treatment modalities were categorized, and patient outcomes were grouped into recovered, deteriorated, or death after treatment.

In the analyzed studies, 28 patients, middle-aged males, were predominantly diagnosed with emphysematous pyelonephritis affecting either right or left kidney, with Escherichia coli identified as the predominant pathogen in urine cultures. Key risk factors included poorly controlled diabetes, immunosuppression, renal transplantation, obstructive uropathy and recurrent urinary tract infection. All patients initially received conservative treatment with antibiotics, antimicrobial therapy, and fluid resuscitation. Minimally invasive procedures were used in 42.8% patients while 50% underwent surgical interventions. Of the 28 patients, 23 survived, with 21 recovering fully and 2 experiencing deteriorations.

The findings of this study emphasize the importance of early identification of risk factors in patients with severe pyelonephritis requiring hemodialysis. Recognizing these factors at an early stage allows for timely and targeted interventions, which can potentially reduce complications and mortality among high-risk patients. In addition, identifying effective treatment methods aid in informed decision-making for managing severe cases. Since this study primarily includes case reports, all results are merely descriptive and intended to generate hypotheses. However, there is a need for large-scale and well-designed studies to better understand the impact of treatment approaches and to establish more evidence-based management strategies for patients with pyelonephritis requiring hemodialysis.