Characteristics of Infections in Hemodialysis Patients: Results from a Single-Center 29-Month Observational Cohort Study from Romania

TL;DR

Hemodialysis patients with kidney disease face higher infection risks and mortality, with specific bacteria and risk factors like hypotension and male sex contributing to poor outcomes.

Contribution

The study identifies hemodialysis as an independent risk factor for in-hospital mortality in infected CKD patients, emphasizing the need for antimicrobial surveillance.

Findings

Hemodialysis patients had a 46.7% in-hospital mortality rate compared to 15.4% in non-HD patients.

Staphylococcus aureus, Klebsiella pneumoniae, and Escherichia coli were the most common pathogens.

Hypotension and male sex were additional independent risk factors for mortality in infected CKD patients.

Abstract

End-stage chronic kidney disease markedly increases susceptibility to infections due to compromised immune function and other physiological alterations. Bacteremia is responsible for higher mortality rates in hemodialysis patients compared to the general population. Our study aimed to investigate the incidence and clinical outcomes among patients with end-stage CKD and associated infections. The study retrospectively analyzed admitted patients between 1 January 2023 and 31 May 2025. Among 56 hospitalized patients with CKD and infection (30 hemodialysis [HD], 26 non-HD), baseline comorbidity profiles were broadly comparable. Microbiology was frequently positive (46/56, 82.1%), dominated by Staphylococcus aureus (25/98, 25.5%), Klebsiella pneumoniae (19.98, 19.4%), and Escherichia coli (15/98, 15.3%). Crude in-hospital mortality was higher in HD (46.7% vs. 15.4%; p = 0.012; RR 3.03). In multivariable logistic regression, HD remained independently associated with death (adjusted OR 38.22, 95% CI 1.55–940.53; p = 0.026), alongside hypotension (OR 17.55, 1.46–210.92; p = 0.024) and male sex (OR 4.41, 1.29–15.11; p = 0.018); model performance was strong (AUC 0.867). In this single-center cohort of infected patients with end-stage CKD, maintenance hemodialysis was independently associated with higher in-hospital mortality, even after adjustment for age, sex, comorbidity burden, hypotension, and length of stay; hypotension and male sex were additional risk factors. LOS and most presenting features did not differ meaningfully by dialysis status. Our findings also emphasize the urgent necessity for heightened surveillance of local antimicrobial resistance patterns and underscore the profound vulnerability of hemodialysis patients to severe infectious outcomes, which is exacerbated by immunosuppressive conditions and the limited efficacy of available therapeutic options against resistant pathogens.

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