Infections and Chronic Kidney Disease

What is an infection?

An infection occurs when harmful bacteria or viruses enter the body. These germs can enter the body in a variety of ways: through touch, through the air we breathe or through our mouths. Your body’s immune system is on constant alert for infection and has a variety of strategies to combat it.

One of these strategies is increasing blood flow to the infection site. This transports white blood cells and antibodies to fight the invading germs. Sometimes this increased blood flow can make the infection site swollen, tender and hot to the touch. This is called inflammation, and it is one of the first signs of a bacterial infection.

When an infection, like a cold or the flu, is not specific to one area, but affects your entire body, you may develop a fever. Increasing the body’s internal temperature is one way your immune system weakens the bacteria or virus, allowing your antibodies to fight them. A fever is also one of the first signs your body is fighting bacteria or a virus.

As your body continues to fight the infection, it may call upon more of your energy and resources. You may feel tired. This is a sign that your body wants you to rest. Your body wants to use its energy to fight your illness. Sometimes an infection can be overwhelming to your body. As more of the body’s resources are devoted to fighting the infection, less energy is available to maintain needed life functions. This is a stage when medical attention is necessary to help your body defeat the infection.

Why are people with kidney disease prone to infections?

People with kidney disease often face unique challenges when it comes to infection. They can be more prone to infection because of related conditions such as diabetes, inadequate calorie and protein intake due to poor appetite and the access site can be vulnerable to infection.

Diabetes-related infections

If you have been diagnosed with diabetes and have chronic kidney disease, you may also be at risk for diabetes-related infections. Too much glucose (sugar) in the blood prevents white blood cells, which are one of the main defenses against infection, from doing their jobs. It is important to monitor glucose levels carefully and maintain a good range.

People with diabetes may also take a longer time to recover from an infection. A viral infection from the flu, or a bacterial infection from a cut or surgical procedure, can cause blood glucose levels to increase. Even diabetics who usually have great glucose control can find if difficult to maintain their glucose levels in a healthy range when they have an infection. This weakens the body’s ability to fight infection, and could lead to a longer recovery time.

Access sites

An access site is an area of the body where a needle or catheter is inserted to perform dialysis. For peritoneal dialysis (PD) patients, the access site is a catheter that is located in the abdomen. The catheter is a hollow, plastic tube that is inserted into the peritoneum (in the abdominal cavity). It is a direct passageway for delivering and removing the dialysis solution into and out of the body.

For hemodialysis, some patients first starting dialysis will have a temporary catheter in their neck or chest until their more permanent vascular access matures. Hemodialysis patients often have a vascular access site on their arm. This access site is surgically created. This is where needles will be inserted to perform the hemodialysis treatment.

Because access sites allow for the entry and exit of dialysate (for PD), or blood (for hemodialysis), either through a catheter or through puncture with a needle, they can also serve as a possible entry site for bacteria.

Keeping infection at bay

Infections can be small nuisances or become life threatening if allowed to spread throughout the body. Kidney disease and dialysis patients can take precautions against infection by following these general guidelines:

  • Keep your access site clean and monitor it frequently. If you are on dialysis, you will be instructed on how to keep your access site clean and look for any signs of infection. For those who perform home dialysis (peritoneal or home hemodialysis), you will be instructed on the importance of hygiene and will be given a list of procedures to make sure your self treatment is safe. One of the most important procedures for at home dialysis patients is making sure you, or whomever may be helping you, wash hands before handling your catheter or access. Germs can spread through touch.

Peritoneal dialysis patients should also inspect their catheter and the skin surrounding it carefully. Look for signs of damage to the catheter, such as cracks. Tiny cracks or openings can be prime hiding spaces for bacteria. The skin around your catheter should look healthy; watch for any signs of infection such as redness or irritation, or bleeding.

For those on hemodialysis, you will also be instructed on how to care for and monitor your catheter or vascular access. After vascular access surgery, you will be given instructions how to clean and care for your access site to prevent infection.

If you receive your dialysis at a facility, make sure you clean your access site before the dialysis treatment begins. The technician, or nurse, who will be inserting the needle into your access are trained to wash their hands and put on gloves before starting treatment. Only new, sterile needles will be inserted into your access, and the access site will be cleaned beforehand. Report any signs of tenderness or irritation in your access site to your renal nurse and your doctor.

  • Wash your hands! Washing your hands is not only important before handling your access site, it’s also important in helping to prevent illness, such as a cold or the flu. Cold and flu germs can be on doorknobs, sink faucets, even newspapers. If you touch something that someone who is ill has touched, you risk getting the same infection. During cold and flu season, it’s especially important to wash your hands on a regular basis.
  • Manage your condition. Managing your condition is one of the most important things you can do to stay healthy and infection-free. By following your healthcare team’s recommendations regarding diet, medication and dialysis treatments, you can lower your risk of infection.

Keep your regular dialysis appointments. Missing dialysis means waste and toxins build up in your bloodstream, leaving you weak, ill and prone to infection. If you are diabetic, keeping your glucose levels within a target range can help your immune system battle any unwelcome bacteria or viruses. Taking your prescribed medications will also help manage any health conditions you may have. If you have any concerns about your medication, talk to your doctor. Don’t stop taking your medicine unless you have your doctor’s approval. If your doctor has prescribed antibiotics to treat an infection, follow his instructions carefully and do not stop or miss a dose.

  • Eat nutritious foods. The saying, “You are what you eat,” is particularly true when it comes to our bodies. Your body relies on nourishment from food to build its immune system and keep healthy. Consuming adequate amounts of protein, calories and nutrients is important. If you are on dialysis, your renal dietitian has created an eating plan based on your individual nutrition needs to help keep you healthy. Each month your albumin will be checked on your lab report. A low albumin below 4.0 may be a sign of inflammation, infection or inadequate protein intake. Some nutrients linked to improving the immune system must be carefully regulated. For example, large doses of vitamin C should be avoided by dialysis patients. Check with your dietitian first, if you would like to add any foods or supplements that have not been included on your diet or prescribed for you.
  • Report any signs of infection to your doctor right away. Infection to your access site should be reported to your doctor right away so it can be treated immediately. Without a functioning access site, you may not be able to receive dialysis. Also, infections to an access site can spread rapidly through the body, complicating your treatment and delaying your recovery time.

Consult your doctor if you have a cold or the flu. He will want to monitor your condition to make sure it does not worsen.

People with diabetes should routinely examine their feet for blisters, sores, ingrown nails or other problems. They are at increased risk of infection to the feet and lower legs due to the effects of diabetes on the circulation and nerves. Keep up with regular dental checkups. Gum disease and infected teeth are often overlooked as a source of infection.

Although many infections can just be irritating, a small infection can grow and affect your well-being. Kidney disease and dialysis patients must be aware of infection in order to get treatment when necessary and stay healthy.

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