Septicemia, access, cardiovascular disease, and death in dialysis patients

Survival expectations of dialysis patients remain a cause for pessimism. For example, a 49-year-old dialysis patient in the United States can expect to survive a further 6 - 9 years, approximately one third of that expected from general population data. Awareness of the importance of cardiovascular disease (CVD) in dialysis patients has grown dramatically in the past decade. Figure 1 summarizes the annual accrual of citations, derived from a PubMed search performed in May 2005, and shows dramatic growth in research activity in the arena of CVD. Using the terms "dialysis (cardiac or heart or vascular or cardiovascular)," the years 1990 and 2004 yielded 340 and 1103 citations respectively, a 3.2-fold increase. Activity in the arena of dialysis-related infection also grew during this time, albeit less dramatically. Using the terms "dialysis (sepsis or septicemia)," the annual citation rate grew 2.4-fold, from 44 and to 104 citations. Thus, Figure 1 might suggest that septicemia has become relatively less interesting to the nephrologist, given the progressive increase in the citation ratio ("cardiovascular" citations divided by "septicemia" citations), which grew from 7.7 in 1990 to 10.6 in 2004 (p = 0.0018). Clinical experience would suggest that septicemia is not a trivial issue and recent observational and mechanistic studies suggest that septicemia may be a major threat A graph is presented. To quality and quantity of life in contemporary dialysis populations. The objectives of this review are as follows: 1. Describe the clinical epidemiology of septicemia in dialysis patients; 2. Review the link between septicemia and CVD and death in dialysis patients; 3. Discuss potential interventions to reduce the burden of dialysis-related infection; and 4. Discuss issues confronting hemodialysis (HD) and peritoneal dialysis (PD) patients regarding infection.