Infection prevention in home dialysis.

IF 2.2 3区医学 Q3 PERIPHERAL VASCULAR DISEASE Current Opinion in Nephrology and Hypertension Pub Date : 2025-01-01 Epub Date: 2024-10-14 DOI:10.1097/MNH.0000000000001032

Muthana Al Sahlawi, Christopher T Chan, Jeffrey Perl

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Abstract

Purpose of review: Among patients with kidney failure, home dialysis modalities, including peritoneal dialysis (PD) and home hemodialysis (HHD) provide several individual and healthcare system benefits over in-center hemodialysis (HD). Infection remains a major source of morbidity and mortality in this population, and a core outcome of critical importance to patients, caregivers, and kidney health professionals. This narrative review provides evidence-based measures for infection prevention among individuals receiving home dialysis, with a particular emphasis on dialysis and access-related infections.

Recent findings: Patient and care partner education and training is an important and major theme for infection prevention in home dialysis. In PD, identifying and managing modifiable risk factors for infections such as hypokalemia, constipation, use of gastric acid suppressants, and domestic pets, along with the use of antimicrobial prophylaxis, when indicated, can substantially reduce peritonitis risk. Reducing the use of central venous catheters (CVC), and duration of CVC dependence is the most effective means of prevention of HD access-related bloodstream infections in individuals receiving HHD. For arteriovenous fistula cannulation, rope ladder technique is associated with lower risk of infection compared to buttonhole cannulation.

Summary: Developing and instituting a well structured and evidence-based patient training and education program within home dialysis units is the most important measure in preventing and reducing dialysis and access-related infections. Kidney care providers should be familiar with different infection risk factors among individuals receiving home dialysis.

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家庭透析中的感染预防。

审查目的：在肾衰竭患者中，与中心血液透析（HD）相比，包括腹膜透析（PD）和家庭血液透析（HHD）在内的家庭透析方式可为个人和医疗系统带来诸多益处。感染仍是这一人群发病和死亡的主要原因，也是对患者、护理人员和肾脏健康专业人员至关重要的核心结果。这篇叙述性综述提供了预防家庭透析患者感染的循证措施，并特别强调了与透析和通路相关的感染：患者和护理伙伴的教育和培训是家庭透析中预防感染的重要主题。在透析过程中，识别和管理可改变的感染风险因素，如低钾血症、便秘、使用胃酸抑制剂和家养宠物，并在必要时使用抗菌药物预防，可大大降低腹膜炎的风险。减少中心静脉导管 (CVC) 的使用和对 CVC 的依赖时间是预防接受血液透析治疗的患者发生与血液透析相关的血流感染的最有效方法。对于动静脉内瘘插管，与扣眼插管相比，绳梯技术的感染风险更低。总结：在家庭透析室中制定和实施结构合理、以证据为基础的患者培训和教育计划，是预防和减少透析和入路相关感染的最重要措施。肾脏护理人员应熟悉接受家庭透析者的不同感染风险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Opinion in Nephrology and Hypertension 医学-泌尿学与肾脏学

CiteScore

5.70

自引率

6.20%

发文量

132

审稿时长

6-12 weeks

期刊介绍： A reader-friendly resource, Current Opinion in Nephrology and Hypertension provides an up-to-date account of the most important advances in the field of nephrology and hypertension. Each issue contains either two or three sections delivering a diverse and comprehensive coverage of all the key issues, including pathophysiology of hypertension, circulation and hemodynamics, and clinical nephrology. Current Opinion in Nephrology and Hypertension is an indispensable journal for the busy clinician, researcher or student.