Preventing Bloodstream Infections in People on Dialysis: A CDC Vital Signs

At a glance (CDC Vital Signs, February 2023):

• 100× — adults on dialysis were 100 times more likely than other adults to have a staph bloodstream infection in 2017–2020.
• 40% — Hispanic patients on dialysis had a 40% higher risk of these infections than White patients, after accounting for sex, access type and surveillance site.
• 33% — Black people are 33% of all U.S. dialysis patients but 12% of the U.S. population.

Why dialysis is risky

More than 800,000 people in the United States live with end-stage kidney disease, and more than half belong to a racial or ethnic minority group. High blood pressure and diabetes raise the risk of developing it. Some people get a kidney transplant, but most go on dialysis, which filters waste and excess fluid from the body.

Dialysis means entering the bloodstream again and again with needles or catheters (soft plastic tubes placed in large veins). Germs that get into the blood can cause serious infections, sepsis — a life-threatening immune reaction — and death. The most common culprit is Staphylococcus aureus, or staph, which can be hard to treat and deadly; some strains resist the most common antibiotics.

In 2020, more than 14,000 bloodstream infections occurred in U.S. dialysis patients, more than one in three caused by staph. The good news: these infections have fallen since 2014 as proven prevention practices spread.

Who is hit hardest

• Race and ethnicity. End-stage kidney disease affects Black and Hispanic people more than White people, partly because they more often have high blood pressure and diabetes; they also receive different therapies and treatments. More Black and Hispanic dialysis patients get staph bloodstream infections than White patients, though factors besides race and ethnicity may be at work.
• Social and economic factors. Poor access to kidney disease prevention and care, socioeconomic and insurance status, and too little patient education about treatment options all shape differences in treatment. Staph bloodstream infections are more common in areas with more poverty, more household crowding and less education.

The access type matters most

How a patient's bloodstream is connected to the dialysis machine — the vascular access — is the biggest risk factor, whatever a person's race, ethnicity or income. There are three types: a fistula (lowest risk), a graft, and a central venous catheter (highest risk).

What can be done

Bloodstream infections are preventable in every dialysis patient. Health care and dialysis providers, their partners and public health professionals can help, with extra attention to the groups most affected:

• prevent and manage diabetes and high blood pressure, and find and treat chronic kidney disease early, to avoid the need for dialysis;
• counsel patients on treatment options, in their preferred language, before they reach end-stage kidney disease;
• coordinate patients, nephrologists, vascular access surgeons, radiologists, nurses, nurse practitioners and social workers to reduce catheter use;
• give patients culturally appropriate resources on preventing infection and on the risks of each access type, especially catheters;
• lower barriers to care with transport help, insurance expertise, social work and education in several languages;
• keep applying proven infection-control practices in every dialysis facility.

Better data would help too: tracking dialysis bloodstream infections by race, ethnicity, socioeconomic factors and access type, and more research on how these differences affect people on dialysis.

Sources

• CDC, Vital Signs, "Preventing Bloodstream Infections in People on Dialysis" (February 2023). https://www.cdc.gov/vitalsigns/dialysis-infections/index.html
• The full report: MMWR, February 6, 2023. ASL videos: English, Spanish.
• Infographics: CDC. The page's decorative icons and its photo collage, which looks like stock photography, are left out.
• Rewritten in hubnx's own words.