In addition to infections associated with dialysis access devices, patients with end-stage renal disease (ESRD) who require renal replacement therapy may be susceptible to non-access-related infections. Diagnostic strategies for these infections are similar to those used for patients without renal failure. However, a higher index of suspicion and a lower threshold for the initiation of a search is appropriate since patients with ESRD are frequently diabetic and/or immunosuppressed because of the retention of uremic toxins. Careful attention to appropriate dosing of antibiotics and the avoidance (if possible) of nephrotoxic drugs in the patient with residual renal function are also significant issues.
Many of the infections reviewed in this topic are not unique to the dialysis patient. As a result, although the likelihood of their occurrence may be increased, special considerations and guidelines for the dialysis patient are not available. Diagnostic and treatment strategies must be tailored to the individual patient, including the consequences of kidney failure and other comorbid conditions, the geographic location, and specific environmental exposures.
A review of the clinical characteristics of infections not related to the dialysis access is presented here. Reviews of access-related infections and the clinical manifestations and treatment of sepsis in dialysis patients, a complication most commonly due to infection of dialysis access devices, are discussed separately. (See "Tunneled, cuffed hemodialysis catheter-related bacteremia" and "Non-thrombotic complications of chronic hemodialysis arteriovenous vascular access" and "Clinical manifestations and diagnosis of peritonitis in peritoneal dialysis".)
Data from the United States Renal Data System (USRDS) indicates that infections are a leading cause of death among patients with end-stage renal disease (ESRD) , accounting for approximately 15 percent of all fatalities . The vast majority result from bacteremia/sepsis, followed by pulmonary infection .
Compared with the population with normal kidney function, patients with chronic kidney disease (CKD) and ESRD are at higher risk of contracting bacterial infections, particularly urinary tract infections, pneumonia, and sepsis [3,4].