Tubes called catheters that are used to draw and return blood to the body during dialysis appear to cause the majority of bloodstream infections in people receiving dialysis for kidney problems, a new study finds.
Three-quarters of bloodstream infections in dialysis patients were related to accessing their blood, the 2014 US Centers for Disease Control and Prevention data showed.
The information came from more than 6 000 outpatient dialysis centres in 2014. There were nearly 30 000 bloodstream infections reported, the study found.
The analysis also found that 63% of all bloodstream infections and 70% of access-related bloodstream infections occurred in patients with a central venous catheter – also called a central line. Other dialysis complication rates were also highest among patients using central venous catheters, the findings showed.
Staphylococcus aureus was the most common bacterial cause of bloodstream infections (31%). 40% of the S. aureus samples were resistant to the antibiotic methicillin ("MRSA"), the investigators found.
Dialysis not available for everyone
Dialysis is necessary in the case of end stage kidney failure when your own kidneys can no longer filter your blood, i.e. when you have lost more than around 85% of your kidney function.
Healthy kidneys filter out excess fluid and wastes. The kidneys also produce hormones that keep your bones strong, blood chemically balanced and stimulate your bone marrow to make red blood cells. These cells carry oxygen in your blood to your organs.
Since 2012 dialysis patients in South Africa are able to undergo dialysis at night. National Renal Care (NRC), South Africa’s largest private dialysis therapy provider and a joint venture between Netcare and Adcock Ingram Critical Care, has introduced a groundbreaking new nocturnal or overnight, dialysis programme.
It is estimated that in South Africa only about a third of those living with kidney conditions are receiving life-saving dialysis.
Other options available
Dialysis patients have an increased risk for infection due to the repeated need to access their blood, the study authors explained.
"Our findings emphasise the need for haemodialysis facilities to improve infection prevention and vascular access care practices," study author Dr Duc Bui Nguyen, from the CDC, said in a news release from the American Society of Nephrology.
The study authors said there are other options available for dialysis patients, such as an arteriovenous fistula. This is created by connecting a patient's own vein and artery to form a long-lasting site through which blood can be removed and returned.
Another option is an arteriovenous graft, which is a plastic conduit between an artery and a vein, the researchers said.
Findings from the study were published in the Clinical Journal of the American Society of Nephrology.
In an editorial accompanying the study, Dr Dana Miskulin of Tufts University School of Medicine and Dr Ambreen Gul of Dialysis Clinic, Inc., explained that part of the problem may be that dialysis units have been placed on an "honour system" when it comes to reporting adverse events.
The editorialists "make a plea to the dialysis community to 'clean up' the data, so that the quality incentive programme is fairer for all, and to enable the full potential of these data... to be realised."