DOI: http://dx.doi.org/10.18203/2349-3933.ijam20213166

Study of sepsis and its markers in renal failure patients on hemodialysis

Prachi Dubey, Sanjay Varma, Bhuwan Sharma

Abstract


Background: Patients with chronic kidney disease have impaired immunity due to disease per se and because of immunosuppressant treatment used for their disease. Catheters used for hemodialysis acts as conduit for microorganisms to cause infections. This leads to increase in morbidity and mortality.

Methods: 100 patients of renal failure requiring hemodialysis were selected. Relevant pathological and radiological investigation done to rule out already existing infection, later on tests were repeated after catheter insertion and hemodialysis to check for infection and sepsis. Using appropriate statistical analysis was done and p value <0.05 was taken as significant.

Results: Out of 100 patients underwent study, 15 developed catheter related blood stream infection. Older age, history of diabetes, male sex, diabetes, anemia, hypoalbuminemia, hyperphosphatemia, prolonged duration of hemodialysis and site of hemodialysis catheter were found to be risk factor for infection.

Conclusions: Patients requiring hemodialysis, who are having non modifiable risk factors like age, sex other risk factors for infection should be controlled to reduce incidence of infection.

 


Keywords


Sepsis, Chronic kidney disease, Hemodialysis, Blood stream infection

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References


National Kidney Foundation: K/DOQI clinical practice guidelines for chronic kidney disease: Definition, identification, and prediction of CKD progression Kidney International Supplements. 2013;3:63-72.

Smith PS. Management of end-stage renal disease in children. Ann Pharmacother. 1998;32:929-39.

Kessler M, Hoen B, Mayeux D. Bacteremia in patients on chronic hemodialysis A multicenter prospective survey. Nephron. 1993;64:95-100.

Sarnak MJ, Jaber BL. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int. 2000;58:1758-64.

Hirasawa H, Oda SH, Nakamura M. Blood glucose control in patients with severe sepsis and septic shock. World J Gastroenterol. 2000;15(33):4132-6.

Fletcher SJ, Bodenham AR, Bodenham AR. Catheter-related sepsis: an overview—part 2. Br J Intensive Care. 1999;9:74-80.

Biesen WV, Vanholder R, Lameire N. Defining Acute Renal Failure: RIFLE and Beyond. CJASN. 2006;1(6):1314-9.

American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864-74.

Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous catheter related infection. N Eng J Med. 1997;296(23):1305‐9.

Chukwu BF, Okafor HU, Ikefuna AN. Asymptomatic bacteriuria in children with sickle cell anemia at The University of Nigeria teaching hospital, Enugu, South East, Nigeria. Ital J Pediatr. 2011;37:45.

Quillei N, Audibert G, Conroy MC, Bellart PE, Guillemin F, Carrie J. Differential Quantitative Blood Cultures in the diagnosis of catheter related sepsis in intensive care unit. Clin Infect Dis. 1997;25:1066‐70.

Hung KY, Yen CJ. Infections associated with double lumen catheterization for temporary hemodialysis. Nephrol Dial Transplant. 1995;10:247‐51.

Qureshi AL, Abid K. Frequency of catheter related infections in haemodialysed uraemic patients. J Pak Med Assoc. 2010;60(8):671-5.

Nagarik AP, Soni S, Barnela S, Gondane S, Kishan AG, Anuradha. Bacteremia Following Temorary Hemodialysis Catheter Insertion: a prospective study. Indian J Nephrol. 2007;17:124.

Powe NR, Jaar B, Furth SL. Septicemia in dialysis patients: Incidence, risk factors, and prognosis. Kidney Int. 1999;55:1081-90.

Pooja G, Set R, Mehta K, Shastri J. Incidence of bacteremia associated with central venous catheter in patients on hemodialysis. Int J Pharm Sci. 2011;3.

Punit G, Khunte P, Dubey P, Gupta GB. Catheter Related Infection In Geriatric Population On Hemodialysis, A Study From Central India. Rep Opinion. 2014;6(5):24-6.

Robinson JL, Casey LM, Huynh HQ, Spady DW. Prospective cohort study of the outcome of and risk factors for intravascular catheter-related bloodstream infections in children with intestinal failure. J Parenter Enteral Nutr. 2014;38(5):625-30.

Kairitis LK, Gottlieb T. Outcome and Complications of temporary hemodialysis catheters. Nephrology Dialysis Transplant. 1994;14:1710‐4.

Jean G, Charra B, Chazzot C, Laurent G. Risk factor analysis for long term dialysis Catheter related Bacteremias. Nephron. 2000;91:399‐405.

Hoen B, Paul-Dauphin A, Hestin D, Kessler M. A multicenter prospective study of risk factors of bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9:869-87.

Parameswaran R , Sherchan JB, Varma DM, Mukhopadhyay C, Vidyasagar S. Intravascular catheter-related infections in an Indian tertiary care hospital‖ J Infect Dev Ctries. 2011;5:452-8.

Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: A prospective study. Kidney Int. 2000;58:2543-5.

Plevkova J. Systemic inflammatory response syndrome. JFMED. 2011;122-4.