Punit Gupta
J.N.M. Medical College, India
Title: A Study of infection related complications in Renal Failure patients on Hemodialysis from developing countries
Biography
Biography: Punit Gupta
Abstract
Aims : this study was done to know the incidence of infections and sepsis in hemodialysis patients, also the risk factors and bacteria, commonly associated with CVC infection in hemodialysis patients.
Methods : We conducted a prospective study in (Nephrology unit) at Dr. B.R.A.M. Hospital Raipur in a total 100 patients. Prospective surveillance for hemodialysis catheter related blood stream infections (CRBSI) was performed in all hundred patients in whom CVC was the access. Blood culture and Maki’s semiâ€quantitative method for catheter tip were used for processing.
Results : In the study group of a total of 100 patients, 35 patients suffered from septicemia whose blood culture was found to be positive for gram positive cocci and gram negative bacilli and they had signs and symptoms of sepsis. All patients had sepsis secondary to catheter related blood stream infection. Out of 35 patients, 34 patients were chronic kidney disease and one suffered from Acute Kidney Injury. The maximum number of patients were in age group more than 45 years with male preponderance. (11%) patients suffered from urinary tract infection, 35 patients (15%) had CRBSI (Catheter related Blood Stream Infection) and 2 (2%) had pneumonia. 40% patients were diabetic. 92% cases in our study group with sepsis had moderate anemia (<11gm%). Gram positive cocci (Staphylococcus aureus) was most common organism found in blood of 80% patients of renal failure on haemodialysis with sepsis and E.coli, Acinectobacter and Candida was found 6.66%, 6.67%, 6.67% respectively. Incidence of sepsis was high with femoral vein (66.67%) usage and prolonged hemodialysis. Serum Phosphorus level was high in 73.33% patients and CRP was raised in all 15 patients with sepsis. Hypoalbuminemia (Serum Albumin level < 3.4 gm/dl) was associated with sepsis in 60% cases. Most of the patients were euthyroid.
Conclusion: As incidence of renal failure requiring hemodialysis increases and accordingly use of vascular access to deliver haemodialysis therapy has increased. The patient requiring haemodialysis are prone to infections because of risk factors like advanced age, male sex, diabetes, anemia, hypoalbuminemia, hyperphosphatemia and prolonged duration of hemodialysis.The site of vascular access is an important risk factor for development of sepsis. Gram positive cocci(S. aureus) is the commonest cause of sepsis. Prevention of CRBSI by encouraging AV Fistula, minimizing the use of CVCs, use of preventive measures for s. aureus cariers and aggressive management of hyperphosphatemia with phosphate binding agents can reduce incidence of CRBSI.