Introduction:
Dialysis population is at a higher risk of infective endocarditis (IE) , mainly due to recurrent episodes of bacteremia . The risk of IE is almost 16-18 times more than the general population . Uremia related immunosuppression and accelerated valvular calcification are some of the other factors that predispose the dialysis population to IE .However , the most important risk factor is presence of an indwelling catheter. Although the risk of bacteremia with indwelling catheter is well established , the association of IE with dialysis access is not very clear.
Methods:
We retrospectively analysed patients with Chronic kidney disease (CKD) on maintenance hemodialysis admitted to our centre with Infective endocarditis .Modified Duke's criteria was used to confirm diagnosis of IE. The risk factors , vascular access for dialysis and its duration , microbiological spectrum of organisms implicated , management and outcome of these patients were studied .
Results:
A total of 15 admitted cases of CKD stage 5 patients with IE were identified from the hospital database during a 5 year period ( between 2019 to 2023) . The average age of these patients was 57.6 +/- 14.9 years and included 14 males. Fifty three percent of them were diabetics and 1 patient was on immunosuppressive drugs . Only one patient had a history of rheumatic disease operated in the past , while 2 of them had history of superior vena cava stent placement in the past . Among the 15 patients , 6 of them had a history of multiple access failure ,10 patients ( 66%) had a history of catheter related bloodstream infection in the past . The access for dialysis was tunnelled catheter in 86% of patients and the mean duration of in-dwelling catheter was 9.35 +/- 7.12 months . The most commonly implicated organism was staphylococcus aureus (46%) and 3 patients had fungal IE. Tricuspid valve was involved in 7 patients ,Mitral valve in 4 patients and aortic valve in 3 patients. Some of the common complications seen in these patients were cardio-embolic stroke ( 3 patients ) , sepsis with shock ( 6 patients ) , pulmonary embolism ( 2 patients ) , valvular perforation ( 2 patients ) and valve abscess ( 1 patients ) . Only 4 out of the 15 patients underwent surgery for IE and are presently on follow-up . Two patients who were managed conservatively are also on follow -up . However , 53 percent ( 8 out of 15) had poor outcomes ( 5 deaths and 3 leave against medical advice ) .
Conclusions:
CKD patients on hemodialysis are at a high risk of infective complications like IE. Dialysis catheters serve as a source of infection .IE is associated with poor outcomes in this cohort of patients. A high index of suspicion is warranted for early diagnosis and treatment of this potentially fatal complication.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.