World Kidney Day falls on March 13 Patients with CKD, complicated health conditions and concerns

People with CKD more likely to get infections

CKD impairs immune function of the body due to abnormalities in immune cell functions and decreased production of immune proteins leading to weakened immune system. This makes it harder for the body to defend against infections caused by harmful invaders like bacteria, viruses, fungi and parasites, making them more vulnerable. Most importantly, these patients can develop infections due to some pathogens which are not infectious to healthy people with normal immune functionsSince these people have to be involved in several medical procedures and medications, the risk of getting blood borne infections also increases.Kidney transplant recipients are more vulnerable to infections than the other CKD patients, because they must be on drugs that suppress the immunity (immunosuppressive drugs), most probably lifelong to prevent rejection of the transplanted kidney.

Types of infections common in CKD patients

• Urinary tract infections [UTI]

• Respiratory tract infections

Respiratory tract infections, such as bacterial, viral or fungal pneumonia and tuberculosis are common infections in CKD patients. The common symptoms are cough, difficulty in breathing and fever. These infections occur by inhalation of different pathogens. Early treatment is essential because respiratory tract infections can progress quickly to a state which is untreatable in people with CKD. 

• Abdominal Infections

Patients who are undergoing peritoneal dialysis are at risk of abdominal infections such as peritonitis which is an infection in the abdominal lining caused by pathogens entering the abdomen through the peritoneal dialysis catheters. Symptoms of peritonitis include abdominal pain, fever, and cloudy dialysis fluid, and it requires immediate medical attention. 

Moreover, people with CKD are more likely to develop food poisoning and other abdominal infections like Hepatitis A or diarrhea due to bacteria, viruses or parasites as food borne infections.

• Skin Infections

Skin infections like cellulitis can occur more frequently in people with CKD due to poor blood circulation and swelling in the legs due to fluid overload. It is important to inspect the skin regularly for infected wounds, pustules or skin abrasions, especially in individuals with diabetes. Poor circulation makes it harder for the body to heal cuts or injuries, which increases the risk of infections.

• Fungal Infections

Fungal infections are more common in people with advanced CKD and kidney transplant recipients on immunosuppressive medications. For examples, Candida infections in mouth or blood stream, Aspergillosis or Mucormycosis in lungs or in sinuses, and fungal infections in the brain like Cryptococcosis. They can present with cough, difficulty in breathing, fever, discharge from the nose or headaches. Building construction sites can be a significant source of fungal infections such as Aspergillus infections due to the release of large amounts of fungal spores into the air with dust or debris. Therefore, these places should be avoided.  

• Blood-Borne Infections

People with CKD are at risk of blood-borne infections, such as hepatitis B, hepatitis C, and HIV. These infections can spread through contaminated blood during procedures like dialysis or blood transfusions. It is essential to get regular screenings to detect any blood-borne infections early.

• Practice good hand hygiene and personal hygiene 

Washing hands frequently according to proper techniques with soap and water is one of the most effective ways to prevent infections because most of the infections spread through contaminated hands. An alcohol-based hand sanitizer can also be used for hand hygiene unless the hands are not visibly dirty. Maintaining good personal hygiene is also important for prevention of infection.

• Take respiratory precautions

To reduce the risk of respiratory infections, a well fitted face mask should be worn. Most important thing is to avoid overcrowded places and building construction sites as much as possible. Since any infection can be easily transmitted to them, they should stay away from people who are suffering from fever, cough, difficulty in breathing, skin rash or any other symptoms and should not share anything with them.

• Up to date vaccination

Vaccinations are a key preventive measure for some infections that could be life-threatening for people with weakened immune systems. Types of vaccines will be decided on staging of the CKD and whether kidney transplantation is done or not. Therefore, it is mandatory to adhere to medical advice and receive vaccination such as Hepatitis B, Chickenpox, Influenza and pneumococcal up to date to prevent acquiring infections and complications. Not only that, but these medical records should also be kept with them for future reference. 

• Maintain adequate hydration

Drinking enough fluids is essential for flushing out bacteria from the urinary tract, which helps to prevent urinary tract infections. Medical advice should be taken on the amount of water intake, as too much fluid can strain the kidneys, while too little can increase the risk of infection. 

• Monitor dialysis catheter site

For people on hemodialysis or peritoneal dialysis, it is important to regularly inspect dialysis catheters sites for any signs of infection such as redness, pain, discharge, fever or chills which can be signs of dialysis associated infection.

Cloudy effluent is an alarming sign of infection for those who are on peritoneal dialysis. If there is any suspicion of infection, healthcare provider should be contacted immediately.

• Healthy food and water

Contaminated food and water are the main route of transmitting abdominal infections. Therefore, CKD patients and especially those with kidney transplantation should eat homemade thoroughly cooked hygienically prepared foods. Uncooked or raw fresh foods like salads and fruits should be avoided as much as possible. If they need to be taken, they should be homemade and properly washed. CKD can lead to malnutrition mainly because of poor appetite and protein loss. It can further compromise the immune system. Therefore, a balanced diet which is recommended for CKD patients should be taken.

Boiled and cooled water or filtered water should be consumed for drinking to prevent waterborne infections.

• Avoid pets with risk of infection

Some pets like cats, dogs, and birds, can carry diseases that may be transmitted to humans such as Toxoplasmosis and Histoplasmosis. This possibility is increased with weakening in immunity. Therefore, people who are diagnosed with CKD or following kidney transplantation, pets should be avoided. Especially direct contact with cat feces in instances such as cleaning cat’s litter boxes should be avoided.

• Maintain a healthy lifestyle

There are some other general behavioral changes in life to be considered for a healthy life. They have to be physically active by engaging in daily activities. Smoking should be avoided or consider quitting. If they use alcohol, their intake should be limited. Other contributing factors for worsening kidney damage such as diabetes and hypertension should be controlled as these can further increase the risk of infection.

Mental health and emotional wellbeing are very important. Developing stress management techniques, such as relaxation exercises or talking to a therapist can help improve the quality of life. Additionally, getting enough sleep is crucial for overall health and immune function.

Conclusion- These people should schedule regular clinic visits with their nephrologist to monitor kidney function as well as to maintain good health. Maintaining a strong infection prevention routine and lifestyle modifications according to medical guidance is key to staying as healthy as possible.