Sepsis is a life-threatening medical emergency caused by the body’s extreme response to an infection. This overwhelming reaction can lead to tissue damage, organ failure, and potentially death if not treated promptly. Dialysis is a medical treatment that removes waste products and excess fluid from the blood when a person’s kidneys are no longer functioning adequately. Patients undergoing dialysis face a significantly elevated risk of developing infections that can progress to sepsis.
Systemic Factors Increasing Sepsis Risk
Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) often have a weakened immune system. This impairment makes it more challenging for their bodies to effectively fight off infections. Uremic toxins and other physiological changes associated with kidney failure can alter the function of both innate and adaptive immune responses.
Many individuals undergoing dialysis also experience chronic inflammation. The body’s immune system may be less effective at resolving infections when it is already in a continuous state of alert.
Co-existing health conditions, such as diabetes and cardiovascular disease, are common among dialysis patients. Additionally, poor nutritional status, a frequent issue in this patient population, can impair immune function and reduce the body’s ability to defend against pathogens.
Dialysis Treatment-Related Causes
Dialysis itself introduces specific risks for infection. Vascular access sites, which allow connection to the dialysis machine, are common entry points for bacteria. Catheters, often used for temporary or initial access, carry the highest risk of bloodstream infections.
In contrast, arteriovenous fistulas and grafts, which are surgically created connections, have lower infection rates compared to catheters. However, these access types still require repeated needle insertions for each dialysis session, creating small openings in the skin that can serve as entry points for microorganisms if proper care is not maintained. Contamination can occur during the connection or disconnection of dialysis equipment if sterile techniques are not strictly followed.
For patients receiving peritoneal dialysis, an infection of the abdominal lining, known as peritonitis, is a significant concern. This can occur if bacteria enter the abdominal cavity through the peritoneal catheter. Peritonitis can lead to widespread infection and potentially develop into sepsis.
Environmental and Healthcare Exposure
Dialysis patients frequently visit healthcare settings. This regular exposure increases their likelihood of encountering various pathogens, including antibiotic-resistant strains. Healthcare-associated infections are a notable cause of illness and death in this population.
Beyond the dialysis unit, these patients are also susceptible to common community-acquired infections, such as pneumonia or urinary tract infections. Due to their compromised immune systems, these infections can escalate rapidly and lead to sepsis. Implementing proper hygiene practices is an important measure to prevent such infections.
Maintaining good personal hygiene, including consistent handwashing, and diligently caring for the dialysis access site are important for reducing infection risk. Environmental cleanliness within dialysis facilities, including disinfection of surfaces and equipment, also prevents the spread of germs.