Hispanic, Black Americans on Dialysis Face Higher Risks for Dangerous Infections
Kidney disease patients on dialysis are 100 times more likely to contract a dangerous blood infection than people not receiving the treatment -- and that risk is borne primarily by Hispanic and Black Americans, U.S. government health officials say.
Hispanic patients are 40% more likely than white patients to develop a staph bloodstream infection while on dialysis, according to a new Vital Signs report from the U.S. Centers for Disease Control and Prevention.
Likewise, Black people are 10% more likely than white folks to get a blood infection through dialysis, the study said.
“A comprehensive approach to preventive care that recognizes racial, ethnic and socioeconomic disparities is needed,” the report concluded.
More than 800,000 people in the United States are living with end-stage kidney disease, and 70% of them are treated with dialysis, according to the CDC.
In dialysis, a person's blood is run through a machine that does the work of their failing kidneys, filtering out waste products and removing excess fluid.
More than half of Americans receiving dialysis belong to a racial or ethnic group, the CDC says. About 1 in 3 on dialysis are Black people, and 1 in 5 are Hispanic individuals.
Although it's lifesaving, dialysis comes with risks. Needles or catheters are needed to hook a person up to a dialysis machine, and germs like Staphylococcus aureus can ride into a person's bloodstream via those skin penetrations.
Staph infections in the bloodstream can be serious and potentially deadly. What's more, some strains of staph have developed resistance to some of the most common antibiotics, making them difficult to treat.
“Preventing staph bloodstream infections begins by detecting chronic kidney disease in its early stages to prevent or delay the need for dialysis,” CDC Chief Medical Officer Dr. Debra Houry said in an agency news release.
“Health care providers can promote preventative practices, including methods to manage diabetes and high blood pressure, as well as providing education on treatment options among all patients and particularly those at greatest risk, to slow the progression of chronic kidney disease," she said.
For the study, the CDC reviewed 2020 data from 4,840 dialysis centers. All told, they reported more than 14,800 bloodstream infections to federal officials. About a third of those were staph infections.
Black patients had the highest number of staph infections, with 1,509 reported between 2017 and 2020.
But when the total amount of time on dialysis was taken into account, Hispanic patients tended to run the highest overall risk of a staph blood infection from their treatment.
People in areas with higher poverty, crowded homes and lower education suffered a greater number of staph bloodstream infections, the report added.
Of all the ways patients are hooked to a dialysis machine, receiving treatment through a central venous catheter carried the highest risk of blood infection, according to the study. These are long, plastic tubes that are inserted into a vein, allowing for the transfer of blood to and from the dialysis machine.
“Dialysis-associated bloodstream infections are preventable -- not inevitable,” said Dr. Shannon Novosad, dialysis safety team lead in the CDC's Division of Healthcare Quality Promotion.
“Our data show that use of a central venous catheter as a vascular access type had six times higher risk for staph bloodstream infections when compared to the lowest-risk access, a fistula," Novosad said in the release. “Prevention efforts that equitably promote lower-risk vascular access types and continued use of infection prevention and control best practices can save lives.”
Researchers urged that potential barriers for patients on dialysis be addressed by offering transportation assistance, insurance coverage expertise, social work services and education resources in multiple languages.
The report did contain one piece of good news -- blood infections of patients on dialysis have decreased since 2014, thanks to the widespread use of proven practices to handle infection risk.
The Cleveland Clinic has more about dialysis.
SOURCES: U.S. Centers for Disease Control and Prevention, news release, Feb. 6, 2023; CDC's Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections - United States, 2017-2020, Feb. 6, 2023