Sepsis and Dialysis
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.
Sometimes called blood poisoning, sepsis is the body’s often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and treatment for survival.
Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.
Two types of dialysis
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 some 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, or they can choose shorter, more frequent sessions. Nocturnal home hemodialysis is another option. The treatments are done overnight while you sleep.
Peritoneal dialysis is usually done at home. 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 catheter 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.
If someone needs emergency dialysis or only a few sessions, it can be done without the special access. But the veins are not strong enough to tolerate the repeated needles and the extra pressure required for regular dialysis. There are three types access used for hemodialysis:
Arteriovenous (AV) fistula, the most common option:
The AV fistula is a connection between an artery and vein, made by a vascular surgeon. It is usually located in your upper arm or forearm, but it can be done in the leg instead.
The AV fistula allows blood to flow from the artery into the vein. This puts extra pressure and extra blood that in the vein, making the vein larger and stronger. This larger and stronger vein provides easy, reliable access to the blood. Without it, regular hemodialysis sessions wouldn’t be possible.
An AV graft, or bridge graft, is not usually used for long-term hemodialysis. It connects an artery with a vein using a hollow, synthetic tube – one end in the artery, the other in the vein.
The AV graft isn’t as popular as the AV fistula because it has a higher risk of blood clots, it can close up more easily, and it doesn’t last as long.
Vascular access catheter:
This method is used for short-term dialysis. A vascular surgeon inserts the end of a Y-shaped catheter into a central vein in your chest. One of the two openings that make the Y shape allows blood to flow out to the dialysis machine and the other one brings the blood back.
Peritoneal dialysis explained
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:
- More severe kidney failure
- A hernia
- Inflammatory bowel disease
- Scarring in their abdomen.
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
Infection risks associated with dialysis
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:
- Have an invasive device, a catheter, graft, or fistula
- Have a chronic illness that lowers their immune system response
- Take medications that can weaken their immune system
- Usually go to a hospital or clinic, where they may be exposed to healthcare-acquired infections
Signs of infection in an access point
The most common symptoms of an infection in an access point are:
- Red skin around the area
- Skin breakdown
- Pus coming from the area
Infection prevention is paramount for people undergoing dialysis.
Here are some tips:
- Clean the fistula site well before each session. Ask your dialysis team how best to do this.
- Wash your hands thoroughly with soap and water or hand sanitizer before and after your dialysis session
- Wear a mask during tubing connection and disconnection
- Get the flu vaccine every year, unless your doctor says otherwise
- Ask your doctor if there are other vaccines you should get, such as for COVID-19 and hepatitis.
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.
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Posted March 18, 2021.