Infective Endocarditis in Patients on Maintenance Hemodialysis

Background. The relevance of the problem is determined by the increasing prevalence of renal replacement therapy and associated infectious complications, including infective endocarditis (IE) — a disease with high mortality and poor prognosis. Aim. To study the clinical characteristics, laboratory and instrumental parameters, and outcomes of IE in patients undergoing maintenance hemodialysis (HD). Materials and methods. A total of 371 patients with definite IE (modified DUKE criteria) hospitalized between 2000 and 2024 were examined. Of these, 23 patients received maintenance HD at outpatient dialysis centers in the Saratov region. The control group consisted of 348 patients with IE who did not require renal replacement therapy. Results. The mean age of dialysis patients with IE was 51 [38; 56] years, with a dialysis duration of 13 [2; 58.5] months. The prevalence of IE in the studied cohort was 6.2 % (23 out of 371 patients with IE). Positive blood cultures were obtained in 14 (60.8 %) of patients with IE on maintenance HD, with Staphylococcus aureus isolated in 9 (39 %) and Enterococcus in 5 (21.7 %) cases. Left-sided IE localization was observed in the majority of maintenance HD patients (17 (73.9 %)), similar to the comparison group. Patients with IE on maintenance HD exhibited a significantly higher frequency of acute disease progression, diabetes mellitus, and neurological complications (p < 0.05), along with elevated quantitative levels of systemic inflammation markers, such as C-reactive protein and procalcitonin (p < 0.05). The Charlson comorbidity index was higher, and anemia and thrombocytopenia were more severe in patients with IE on maintenance HD (p < 0.05). Hospital mortality in IE patients on maintenance HD was 52.17 %, compared to 17.8 % in the comparison group (OR 4.228, 95 % CI: 1.784–10.02; p < 0.05). Conclusion. IE in patients on maintenance HD is a healthcare-associ ated infection primarily caused by Staphylococcus aureus. IE in maintenance HD patients is characterized by an acute course, severe inflammatory response, and high mortality. Due to the increased risk of IE in maintenance HD patients related to vascular access use and poor prognosis, strict aseptic measures and echocardiographic evaluation in cases of clinical suspicion of IE (e.g., unexplained fever) are recommended. The management of IE in maintenance HD patients requires specific app roaches to antibiotic therapy, dialysis treatment, and prevention to minimize risk factors, necessitating multidisciplinary collaboration among specialists.

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