Epidemiology of Acute Infections among Patients with Chronic Kidney Disease

Abstract

The objectives of this review were (1) to review recent literature on the rates, risk factors, and outcomes of infections in patients who had chronic kidney disease (CKD) and did or did not require renal replacement therapy; (2) to review literature on the efficacy and use of selected vaccines for patients with CKD; and (3) to outline a research framework for examining key issues regarding infections in patients with CKD. Infection-related hospitalizations contribute substantially to excess morbidity and mortality in patients with ESRD, and infection is the second leading cause of death in this population. Patients who have CKD and do not require renal replacement therapy seem to be at higher risk for infection compared with patients without CKD; however, data about patients who have CKD and do not require dialysis therapy are very limited. Numerous factors potentially predispose patients with CKD to infection: advanced age, presence of coexisting illnesses, vaccine hyporesponsiveness, immunosuppressive therapy, uremia, dialysis access, and the dialysis procedure. Targeted vaccination seems to have variable efficacy in the setting of CKD and is generally underused in this population. In conclusion, infection is a primary issue when caring for patients who receive maintenance dialysis. Very limited data exist about the rates, risk factors, and outcomes of infection in patients who have CKD and do not require dialysis. Future research is needed to delineate accurately the epidemiology of infections in these populations and to develop effective preventive strategies across the spectrum of CKD severity.

Predictors of surgical site infection after open lower extremity revascularization

“…25 The association between end-stage renal disease requiring dialysis and increased risk for infection is well established. 26,27 Uremia has been shown to depress the immune system, and patients undergoing chronic hemodialysis may have higher rates of colonization by potential pathogens such as methicillin-resistant Staphylococcus aureus. 28 We found a significant interaction between patient age, frequency of SSI, and 30-day mortality.…”

Risk of Invasive Haemophilus influenzae Type b (Hib) Disease in Adults with Secondary Immunodeficiency in the Post-Hib Vaccine Era

“…Secondary immunodeficiency could be due to multiple reasons, e.g., profound metabolic disturbances and malnutrition due to uremia, as well as the immunosuppressive effect of hemodialysis in chronic renal failure (9,18), impaired respiratory function, chronic inflammation, and therapy with corticosteroids in COPD (8,42) or metabolic disorders and associated obesity in type 2 diabetes mellitus (16). The lowest anti-Hib immunity was detected in myeloma patients, likely caused by a decreased synthesis of normal immunoglobulins due to both malignant transformation of plasma cells and the immunosuppressive effect of chemotherapy (30).…”

Immunogenicity of Human Papillomavirus Recombinant Vaccine in Children with CKD

“…Studies have shown defects in neutrophil function, antigen processing, antibody formation, and cell-mediated immune responses in patients with CKD (25)(26)(27), and hyporesponsiveness to several vaccines have been described in children with CKD (9)(10)(11)(12)(13)(14)(15)(16). However, other vaccines in patients with CKD, such as varicella (28,29), have shown responses similar to those in the general population.…”