Clinical Evaluation and Management of Chronic Kidney Disease

CE: Continuing Education Article PREVENTION OF INFECTION IN PATIENTS WITH CHRONIC KIDNEY DISEASE PART 1: APPLICATION OF INFECTION CONTROL PRINCIPLES TO THE RENAL CARE ENVIRONMENT

“…Although the proportion of deaths from infection amongst dialysis patients has markedly decreased in recent years, declining from more than 40% in the early 1970s to approximately 15% from the 1990s onwards, infection is second only to cardiovascular disease as the most common cause of death in this patient population (Descamps‐Latscha et al 2002). The high susceptibility to infection observed in this patient group reflects a state of chronic immunosuppression, with defects of both cellular and humoral immunity (Descamps‐Latscha et al 1994; Wheeler & Winearls 2007).…”

“…bacteria and viruses. In uraemia, T‐lymphocyte response to antigens (proteins or polysaccharides, which form part of the structure of bacteria and viruses) is impaired and neutrophil activation is defective, culminating in immune system dysregulation in patients receiving dialysis (Descamps‐Latscha et al 2002; Wheeler & Winearls 2007). Immune system dysregulation is well documented in the dialysis population, although immunosuppression is evident in patients with CKD long before the initiation of dialysis therapy (Descamps‐Latscha et al 1994).…”

Chronic Kidney Disease Begins Slowly and Lasts a Long Time

“…Chronic management of patients with early nonprogressive CKD is getting to be the duty of essential care doctors in numerous welldeveloped health care systems, with follow-up in secondary care limited to those likely to advance to ESKD and require KRT [11]. In any case, early appraisal by nephrologists is valuable for all patients recently diagnosed with CKD in whom a treatable fundamental cause is suspected, indeed in those with advanced disease at introduction, to run the show out treatable causes.…”

Prevention of Infection in Patients With Chronic Kidney Disease Part Iii: Surveillance and Auditing in a Renal Care Environment

“…Patients with chronic kidney disease (CKD) are susceptible to infection due to a number of factors including; chronic immunosuppression, frequent hospitalisations and the presence of invasive medical devices (Descamps‐Latscha et al 1994; Wheeler 2007).…”