Dialysis catheter-related bloodstream infections in patients receiving hemodialysis on an emergency-only basis: a retrospective cohort analysis
Open accessAbstract
BACKGROUND: An estimated 6500 undocumented immigrants with end-stage renal disease (ESRD) live in the United States. Those living in states that do not provide undocumented immigrants scheduled hemodialysis receive intermittent hemodialysis only when life-threatening conditions arise. Little is known about catheter-related bloodstream infections (CRBSIs) in this population. METHODS: We conducted a retrospective cohort study of emergency-only hemodialysis patients in the Harris Health System in Houston, Texas, between January 2012 and December 2015. We assessed CRBSI risk factors including demographics, comorbidities, and duration and frequency of hemodialysis. We investigated the microbiologic etiology of these infections, rates of recurrent CRBSI, and associated morbidity and mortality. RESULTS: The cohort included 329 patients; 90% were Hispanic, 60% had diabetes, and the average age was 51 years. A total of 101 CRBSIs occurred, with a rate of 0.84 infections per 1000 catheter-days. Cirrhosis and duration of hemodialysis during the study period were associated with increased risk of CRBSI. Seventeen CRBSIs were recurrent; infection with gram-positive bacteria predicted recurrence. Adherence to catheter-related infection guidelines was improved by infectious diseases consultation and associated with fewer recurrent infections. CRBSI was associated with prolonged hospitalization (mean, 15 days), composite complication rate of 8%, and a 4% mortality rate. CONCLUSIONS: Patients receiving emergency-only hemodialysis via tunneled catheters have a high CRBSI rate compared with infection rates previously reported in patients receiving scheduled maintenance hemodialysis. Increased CRSBI risk likely contributes to the increased morbidity and mortality seen in ESRD patients receiving emergency-only hemodialysis.
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CVCIs have become the second leading cause of mortality among hemodialysis patients.
“CVCIs have become the second leading cause of mortality among hemodialysis patients (44).”
From Construction of nursing-sensitive quality indicators for hemodialysis vascular access: a Delphi study (2026) · cites this paper as [44]
The Results (page not provided) report four deaths from catheter-related bloodstream infection in this emergency-only hemodialysis cohort, compared with 12 from cardiovascular events and eight from other infections. That death count does not support calling catheter-related infection the second leading cause of mortality, and the study does not establish a ranking for hemodialysis patients generally. (LLM, conf=0.84)
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Zhang, Y., He, L., Tang, S., Gao, Y., Chen, H., Shi, M., & Chen, L. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1858484
“CVCIs have become the second leading cause of mortality among hemodialysis patients (44).”
- Authors
- Zhang, H. H., Cortés-Penfield, N. W., Mandayam, S., Niu, J., Atmar, R. L., Wu, E., Chen, D., Zamani, R., & Shah, M. K.
- Affiliations
- Baylor College of Medicine (US)
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston
- The University of Texas Southwestern Medical Center (US)
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-07-09
- Volume
- 68
- Issue
- 6
- Pages
- 1011-1016
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC6399430
- OpenAlex
- W2878740696
- Cited by
- 42
- References
- 0
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 3 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 6 · 2019: 4
- FWCI
- 6.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5T32 AI055413-14)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Central Venous Catheters and Hemodialysis
- Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- catheter-related bloodstream infection, undocumented immigrants, end-stage renal disease, intermittent hemodialysis, Gram-positive bacteria, liver cirrhosis, infectious disease consultation, infection risk factors, morbidity and mortality
- MeSH terms
- Adult, Aged, Emergency Medical Services, Female, Renal Dialysis, Humans, Kidney Failure, Chronic, Male, Middle Aged, Retrospective Studies, Cohort Studies, Sepsis, Disease Management, Catheter-Related Infections
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