End-stage kidney failure is a serious condition. Your kidneys have many functions, but the most important is filtering toxins out of your blood and removing waste. People who develop end-stage kidney failure often need to go on dialysis. This is a procedure that takes over the kidneys’ role. Dialysis is lifesaving, but it has its risks, one of which is an increased risk of infection. And this, in turn, can lead to sepsis.
Sepsis, which was often called blood poisoning, is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.
Suggested Citation:
Sepsis Alliance. Sepsis and Dialysis. 2023. https://www.sepsis.org/sepsisand/dialysis-2/
Updated December 15, 2023.
There are two types of dialysis: hemodialysis and peritoneal dialysis.
About 90% of people who need dialysis receive hemodialysis. Most have the procedure in a hospital or specialized clinic, but there are now home hemodialysis machines, which give patients more control over their time.
The procedure takes about four hours each session, usually three times a week. People who choose home dialysis have more freedom in choosing when and for how long each session is. They may choose to follow the same three sessions per week at four hours each. They can also choose shorter, more frequent sessions. Night home hemodialysis is another option. The treatments are done overnight while you sleep.
Peritoneal dialysis is usually an at-home treatment. The two most common types are continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis. CAPD takes about a half hour or so, usually three to five times a day, every day. While you do need special equipment, there is no special machinery. Automated peritoneal dialysis is usually done at night, using a machine called a cycler.
So how does hemodialysis work? To have hemodialysis, you need a special fistula or graft in your arm for access. This allows your blood to flow from your body into the hemodialyzer and back again. While the blood is in the dialyzer, a special filter draws out harmful substances, waste products, and extra fluid. Once the cycle is complete, a pump in the machine pushes the blood flow back to your body.
The special access is not usually needed for emergency dialysis or only a few sessions. But veins are not strong enough to tolerate the repeated needles and the extra pressure required for regular dialysis.
About 10% of people who need dialysis use this method. It is less restrictive because you aren’t hooked up to a machine for several hours during the day. But it’s not for everyone. People who are not good candidates for peritoneal dialysis are those who are obese or who have:
People who use peritoneal dialysis may have to switch to hemodialysis if the kidney disease progresses.
To have peritoneal dialysis, a surgeon must insert a special permanent catheter into your abdomen. This will allow the dialysate, the special fluid, to flow into your abdomen. After you clamp the catheter closed, the fluid sits in the abdomen for a set period. The abdominal lining (peritoneum) acts as a filter, drawing waste products and extra body fluids into the dialysate. When the time is up, you unclamp the catheter so the fluid can flow out.
Any time there is a break in your skin, even with a surgical procedure, there is a risk of infection. There are two main causes for hemodialysis access to fail: blood clots and infection. Infection in the access is the most common cause of infection among people who undergo hemodialysis.
Someone undergoing dialysis is at higher risk for infection because they:
The most common symptoms of an infection in an access point are:
Infection prevention is very important for people undergoing dialysis.
Here are some tips:
If you suspect you may have an infection, tell someone on the dialysis team immediately. Watch for signs of sepsis and if you have any, call 911 or go to your closest emergency department right away unless your dialysis team has other arrangements for patients with suspected infections. Be sure to tell the emergency personnel that you are a dialysis patient and you are concerned about sepsis.
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End-stage kidney failure is a serious condition. Your kidneys have many functions, but the most important filtering toxins out of your blood and removing waste. People who develop end-stage kidney failure often need to go on dialysis. This is a procedure that takes over the kidneys’ role. Dialysis is lifesaving, but it has its risks, one of which is an increased risk of infection. And this, in turn, can lead to sepsis.
