Candida bloodstream infections in hemodialysis recipients

Abstract

Candidemia is a major cause of morbidity and mortality in patients undergoing hemodialysis but it has not been well defined in this patient population. We performed a retrospective case-control study to characterize the epidemiology, microbiology, and outcomes of hemodialysis-associated candidemia. All cases of candidemia at our institution were evaluated from 1 January 2000 until 1 September 2004. For each case, two non-candidemic dialysis patients served as controls. Among 350 cases of candidemia, 78 (22%) occurred in adult hemodialysis patients. Cases and controls were similar with respect to age, corticosteroid, antibiotics use, prevalence of diabetes mellitus, liver cirrhosis, surgical procedures, and cancer. Multivariate analysis found total parenteral nutrition (TPN) (19.5% vs. 1.3%; P<0.0001) and dialysis through a vascular catheter (74% vs. 46.8%; P=0.0001) to be independently associated with candidemia. Non-C.albicans Candida spp. particularly C. glabrata and C. krusei were more common in hemodialysis recipients than in candidemic patients not receiving hemodialysis (31% vs. 17% p = 0.009). In-hospital mortality was significantly elevated for candidemic vs. non-candidemic hemodialysis recipients (51.9% vs. 7.8%; P<0.0001). Candidemia in hemodialysis recipients is frequently caused by non-C. albicansCandida species, is associated with TPN and dialysis via a vascular catheter (vs. shunt or fistula) and carries a high mortality rate.

The Influence of Hemodialysis on T Regulatory Cells: A Meta-Analysis and Systematic Review

“…Because this finding was apparent in the absence of uremic serum, they concluded that the majority of the functional defect is cell-intrinsic (i.e., the Tregs are defective) rather than cell-extrinsic (uremic toxins, oxidized low-density lipoprotein and hypercytokinemia) [21] . On the other hand, Candida bloodstream infections is one cause of morbidity and mortality in hemodialysis patients [29] and mouse studies have demonstrated that Tregs are required for effective clearance of Candida albicans infections [30] . Thus, effective Treg numbers and functional capacity are important for limiting excess inflammation and properly eradicating some types of infections.…”

Current aspects of invasive candidiasis and aspergillosis in adult intensive care patients

“…A little less striking, haemodialysis may be another of these semi‐specific factors predisposing for IC: in a recent retrospective analysis of 350 cases of candidaemia, 22% were adult haemodialysis patients. Candidaemia was associated with a crude hospital mortality rate as high as 52% in haemodialysis patients 12 …”

Role of caspofungin in restoring the impaired phagocyte-dependent innate immunity towards Candida albicans in chronic haemodialysis patients

“…Candida albicans infections represent a serious clinical complication in patients with chronic kidney disease (CKD) undergoing haemodialysis treatment and are associated with a high mortality rate [1,2]. The greater risk of infection in this population is caused by impaired host immunity through uraemia, which interferes with T-cell and B-cell function, macrophage phagocytosis and antigen presentation [3][4][5][6].…”