Infections in chronic kidney disease

Infectious and cardiovascular (CV) complications take a huge toll on Chronic Kidney Disease and End-Stage Renal Disease patients in terms of morbidity and mortality. Infection leads to increased mortality, directly as a result of infectious disease processes and indirectly as a risk factor for cardiovascular disease. Chronic activation with hyporesponsiveness may be the most accurate description of the immune dysfunction in clinical uremia. Risk factors for infection among patients with CKD or ESRD include high burden of coexisting illnesses, malnutrition, immunosuppressive therapy, uremia and anemia. Infections in dialysis patients could be access related or non-access related. Infections in patients with chronic kidney disease & ESRD are associated with poorer outcomes compared with the general population. Preventive strategies for infection in those with CKD and ESRD are not standardized and are underutilized even in developed countries. Creation of an optimally timed arteriovenous access is the most important step for reducing the risk of infections in hemodialysis patients. Despite the evidence of decreased efficacy of various vaccines, this population should be adequately vaccinated.