Infectious complications in hospitalized patients with chronic kidney disease on renal replacement therapy

An observational study in a fourth-level health center on the Colombian Caribbean Coast (2019-2024).

Abstract

Introduction:  The second cause of mortality in patients with chronic kidney disease is infections, among which the presence of devices such as catheters is a risk factor. This study examines the factors contributing to catheter-related infections among patients with CKD on the Colombian Caribbean Coast.

Methods: The present observational study was conducted at the Clínica de la Costa (Barranquilla, Colombia) from 2019 to 2024. Records of patients on hemodialysis or peritoneal dialysis hospitalized for infections associated with the renal replacement device, with microbiological confirmation by positive culture, were included. The sample was divided into two groups based on hospital outcome: living and deceased. Sociodemographic, clinical, microbiological, and management variables were collected. Percentages are compared with the Chi-square test and the Odds ratio.

Results: A total of 78 cases were analyzed, of which 38 were from the hemodialysis program and 40 from the peritoneal dialysis program; in-hospital mortality was 25.6% (n=20). No statistically significant differences were found in age, sex, or chronic comorbidities, such as hypertension or diabetes, between the groups of survivors and deaths. A history of previous infection and neurological disease was identified as a critical risk factor, increasing the probability of death almost fourfold (OR: 3,714; 95%CI: 1,037-13,309; P=0.036). The fatal outcome was closely linked to septic shock and admission to the ICU, which were present in 100% of the deceased (P < 0.001). Microbiologically, methicillin-resistant S. aureus was the main predictor of mortality, present in 50% of deaths with a significantly higher risk than other pathogens (OR: 117; P=0.0014). No significant association was observed between the type of access device or dialysis modality and patient death.

Conclusion: Survival on renal replacement therapy depends on strict microbiological surveillance and personalization of preventive care in cognitively compromised patients, allowing early intervention before irreversible organ dysfunction sets in.