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Brazilian Journal of Clinical Medicine and Review

Original research

Vol. 4 No. 1 (2026): January/December - 2026

Patients with Acute Kidney Injury Undergoing Hemodialysis: Epidemiology and Factors Associated with Catheter-Related Bloodstream Infection

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr40
Submitted
July 3, 2025
Published
2025-09-10

Abstract

Acute kidney injury (AKI) has a high mortality rate, especially when hemodialysis (HD) is required. Catheter-related bloodstream infection (CRBSI) is a reported complication, with Staphylococcus aureus as the main causative agent. The objectives of this study were to analyze the epidemiological profile of patients undergoing HD for AKI and to identify CRBSI characteristics and outcomes. This was an observational, retrospective study of patients with AKI undergoing HD via non-tunneled double-lumen catheters (LCLC) during hospitalization. Clinical, microbiological, and HD-related data were collected. A total of 290 patients were included (65.9% male; mean age 62.2 ± 2 years); 26.9% were septuagenarians, 49.3% hypertensive, and 35.9% diabetic. Sepsis-related AKI was the leading etiology (33.4%); the mean number of HD sessions was 4.9 ± 3.6 per patient. The incidence of CRBSI was 14.5%; S. aureus was the main agent (30%; 46% MRSA), followed by A. baumannii (9.6%). There was no association between sex, age, or NTDLC insertion site and CRBSI. A higher incidence of CRBSI was observed among those who underwent a greater number of HD sessions (p<0.001). Overall mortality was 54.5%. AKI requiring HD is associated with high mortality, and CRBSI is frequent. The prevalence of elderly patients and multidrug-resistant bacteria in the sample studied is noteworthy.

Method: observational, retrospective study of patients with AKI undergoing HD via non-tunneled dialysis catheter (NTCD) during hospitalization. Clinical, microbiological and HD-related data were collected.

Results: 290 patients were included (65.9% male; 62.2±2 years); 26.9% were in their septuagenarian years, 49.3% hypertensive and 35.9% diabetic. AKI in sepsis was the main etiology (33.4%); mean number of sessions of 4.9±3.6/patient. The incidence of CRBSI was 14.5%; S. aureus was the main agent (30%; 46% MRSA) followed by A. baumannii (9.6%). There was no association between sex, age and site of NTCD with CRBSI. There was a higher incidence of CRBSI in those who underwent a greater number of HD sessions (p<0.001). There was a higher mortality, regardless of CRBSI, if NTCD was in the femoral vein (65.2%; p<0.001). Overall mortality was 54.5%.

Conclusions: AKI in HD is associated with high mortality and CRBSI is frequent. The prevalence of elderly patients and multidrug-resistant bacteria in the studied sample is notable.

References

  1. Reis T, Colares VS, Rocha E, Younes-Ibrahim M, Lima EQ, Andrade LDC, Ponce D, Suassuna JHR, Yu L. Acute kidney injury and renal replacement therapy: terminology standardization. J Bras Nefrol. 2022 Jul-Sep;44(3):434-442. doi:10.1590/2175-8239-JBN-2021-0284en. PMID:35579341; PMCID:PMC9518623.
  2. Kashani K, Rule AD. Improved survival after acute kidney injury: past and future. Clin J Am Soc Nephrol. 2022 Feb;17(2):179-181. doi:10.2215/CJN.16351221. PMID:35131925; PMCID:PMC8823940.
  3. Lewington AJ, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int. 2013 Sep;84(3):457-467. doi:10.1038/ki.2013.153. Epub 2013 May 1. PMID:23636171; PMCID:PMC3758780.
  4. Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, Susantitaphong P, Rocco M, Vanholder R, Sever MS, Cruz D, Jaber B, Lameire NH, Lombardi R, Lewington A, Feehally J, Finkelstein F, Levin N, Pannu N, Thomas B, Aronoff-Spencer E, Remuzzi G. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015 Jun 27;385(9987):2616-2643. doi:10.1016/S0140-6736(15)60126-X. Epub 2015 Mar 13. PMID:25777661.
  5. Lameire N, Van Biesen W, Vanholder R. Acute kidney injury. Lancet. 2008 Nov 29;372(9653):1863-1865. doi:10.1016/S0140-6736(08)61794-8. PMID:19041789.
  6. Griffin BR, Liu KD, Teixeira JP. Critical care nephrology: core curriculum 2020. Am J Kidney Dis. 2020 Mar;75(3):435-452. doi:10.1053/j.ajkd.2019.10.010. Epub 2020 Jan 22. PMID:31982214; PMCID:PMC7333544.
  7. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(1 Suppl 2):S1-S164.
  8. Parvulescu F, Oliver MJ, Reyna ME, et al. Factors affecting cuff extrusion of tunneled hemodialysis catheters. Can Assoc Radiol J. 2022;73(3):410-417.
  9. Sahli F, Feidjel R, Laalaoui R. Hemodialysis catheter-related infection: rates, risk factors and pathogens. J Infect Public Health. 2017 Jul-Aug;10(4):403-408. doi:10.1016/j.jiph.2016.06.008. Epub 2016 Aug 8. PMID:27423929.
  10. Berenholtz SM, Pronovost PJ, Lipsett PA, et al. Eliminating catheter-related bloodstream infection in the intensive care unit. Crit Care Med. 2004;32(10):2014-2020.
  11. Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: a prospective study. Kidney Int. 2000 Dec;58(6):2543-2545. PMID:11115089.
  12. Shahar S, Mustafar R, Kamaruzaman L, Periyasamy P, Pau KB, Ramli R. Catheter-related bloodstream infections and catheter colonization among haemodialysis patients: prevalence, risk factors, and outcomes. Int J Nephrol. 2021;2021:Article ID.
  13. Parienti JJ, Thirion M, Mégarbane B, Souweine B, Ouchikhe A, Polito A, et al. Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial [Internet]. Available from: http://jama.jamanetwork.com/.
  14. Cheng S, Xu S, Guo J, He Q, Li A, Huang L, et al. Risk factors of central venous catheter-related bloodstream infection for continuous renal replacement therapy in kidney intensive care unit patients. Blood Purif. 2019 Aug 1;48(2):175-182.
  15. Melo FAF, Macedo E, Fonseca Bezerra AC, Melo WAL, Mehta RL, Burdmann EA, Zanetta DMT. A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries. PLoS One. 2020 Jan 17;15(1):e0226325. doi:10.1371/journal.pone.0226325. PMID:31951618; PMCID:PMC6968869.
  16. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-c184. doi:10.1159/000339789. Epub 2012 Aug 7. PMID:22890468.
  17. Souza ACSV, Alencar KC, Landim NLMP, Oliveira PM de S, Leite CM de C. Epidemiological profile of morbimortality and public expenditure by renal insufficiency in Brazil. Res Soc Dev. 2020 Aug 28;9(9):e510997399.
  18. Machado DPF. Perfil epidemiológico dos pacientes com insuficiência renal [dissertação na Internet]. Salvador: Escola Bahiana de Medicina; 2023 [cited 2025 Jan 16].
  19. Feest TG, Round A, Hamad S. Incidence of severe acute renal failure in adults: results of a community based study. BMJ. 1993;306(6876):481-483.
  20. Dias RPL, Duarte DB, Barbosa D de CBM, Campos RP. Acute kidney injury in nonagenarians: clinical characteristics and mortality. Braz J Nephrol. 2024 Jul;46(3):e20230088.
  21. Sousa ALB, de Souza LM, Filho OVS, Ferreira VH, Rocha LN, Rocha PNAL. Incidence, predictors and prognosis of acute kidney injury in nonagenarians: an in-hospital cohort study. BMC Nephrol. 2020;21(1):34. PMID:32000715.
  22. Teles F, Santos RO, Lima HMAM, Campos RP, Teixeira EC, Alves ACA, Costa AFP, et al. Impacto da diálise em pacientes críticos idosos com injúria renal aguda: uma análise por propensity-score matching. Braz J Nephrol. 2019;41(1):14-21.
  23. Ponce D, Zorzenon C de PF, Santos NY dos, Teixeira UA, Balbi AL. Injúria renal aguda em unidade de terapia intensiva: estudo prospectivo sobre a incidência, fatores de risco e mortalidade. Rev Bras Ter Intensiva. 2011 Jul;23(3):321-326. doi:10.1590/S0103-507X2011000300010.
  24. Mehta RL, Pascual MT, Soroko S, Savage BR, Himmelfarb J, Ikizler TA, Paganini EP, Chertow GM; Program to Improve Care in Acute Renal Disease. Spectrum of acute renal failure in the intensive care unit: the PICARD experience. Kidney Int. 2004;66(4):1613-1621.
  25. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39(5):930-936.
  26. Susantitaphong P, Cruz DN, Cerda J, Abulfaraj M, Alqahtani F, Koulouridis I, Jaber BL; Acute Kidney Injury Advisory Group of the American Society of Nephrology. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2013 Sep;8(9):1482-1493. doi:10.2215/CJN.00710113. Epub 2013 Jun 6. Erratum in: Clin J Am Soc Nephrol. 2014 Jun 6;9(6):1148. PMID:23744003; PMCID:PMC3805065.
  27. Shingarev R, Barker-Finkel J, Allon M. Natural history of tunneled dialysis catheters placed for hemodialysis initiation. J Vasc Interv Radiol. 2013;24(8):1289-1294.
  28. Oliveira RSM, Conceição KS, Jacob RDES, Araújo AAB, Silva BZ, Teixeira PHM, et al. Impacto das infecções por bactérias multirresistentes em unidades de terapia intensiva. Braz J Implantol Health Sci. 2025;7(4):705-715.
  29. Millan LS, Benedette CEM, Maximo LZ, Almeida PCC, Gomes DS, Gemperli R, et al. Bloodstream infections by multi-drug-resistant bacteria in patients in an intensive care unit for the treatment of burns: a 4-year experience. Rev Bras Cir Plást. 2012;27(3):374-378.