Pathogenic Organisms Causing Respiratory Infections in Patients with Chronic Kidney Disease, Stage V on Maintenance Haemodialysis: A Cross-Sectional Study

Introduction: Pulmonary infections are the most common infectious cause of disability and mortality in Chronic Kidney Disease (CKD) stage V patients on haemodialysis after cardiovascular disease. The incidence of pathogenic invasion of the lungs causing pneumonia is markedly higher in CKD stage V patients undergoing haemodialysis as compared to the general population. The risk is due to various factors including immune dysfunction, prolonged hospital stays leading to contact exposure, and hospital-acquired infections. The other important factors are anaemia, uremic toxins promoting pulmonary oedema, age, and vascular access through the arteriovenous fistula and internal jugular vein leading to catheter-induced respiratory infections.

Aim: To study the common pathogens involved in causing lung infection in CKD stage V patients on maintenance haemodialysis.

Materials and Methods: This cross-sectional study was conducted in the Department of Medicine/Nephrology at Andhra Medical College and King George Hospital, Visakhapatnam, Andhra Pradesh, India. The duration of the study was one month, from June 2019 to July 2019. A total of 50 patients were included in the study with CKD stage V on haemodialysis. The samples were between ages 18 to 75 years with respiratory symptoms and signs including fever, productive cough, and shortness of breath being the major complaints. These patients were subjected to certain investigations to isolate the organism. The parameters assessed were blood culture and sputum culture, haemoglobin, and chest X-ray. Sputum examination for Acid-fast Bacilli (AFB) was done to rule out tuberculosis. Statistical Package for Social Sciences (SPSS) version 17.0 was used for statistical analysis and measurement, data were expressed as the Mean±Standard Deviation (SD).

Results: The majority of the subjects were in the mean age group of 49 years and males were predominantly affected. The commonly isolated organism was gram-negative bacilli-Pseudomonas, with access common through arteriovenous fistula as compared to Escherichia coli (E.coli), which was common in patients with access through Internal Jugular Vein (IJV).

Conclusion: The respiratory infection, that posed the burden in the present study was pneumonia. The common organism isolated was gram-negative bacteria being pseudomonas. The respiratory infections identified, were more through Arteriovenous Fistula (AVF) access and common in patients with moderate to severe anaemia.