Kerala Dialysis Patient Deaths Expose High Infection Risks Faced By Kidney Disease Patients

The recent deaths of two dialysis patients at the Haripad Taluk Hospital in Kerala have shone a spotlight on a sobering reality: People on dialysis face disproportionately high risks of infection and death. According to the Press Trust of India (PTI), Haripad police registered a case of alleged medical negligence against the hospital superintendent and dialysis unit staff after the relative of one of the dead alleged severe infection following dialysis treatment at the facility on December 29. Both men, identified as Ramachandran (60) and Majeed (52), developed fever, vomiting and shivering during dialysis, were shifted to other hospitals, and died later in late December.

Dialysis is a life-sustaining treatment for people with end-stage kidney disease (ESKD) or severely impaired renal function, but it inherently involves frequent access to the bloodstream. This access, whether through needles for haemodialysis or catheters, increases vulnerability to bloodstream infections and other serious complications. Reliable health data show infections are among the leading causes of hospitalization and death in dialysis patients worldwide, second only to cardiovascular disease in many settings. 

Understanding why people on dialysis are at heightened risk, and how improvements in infection control, vascular access practices and overall care can mitigate those risks, is vital for both clinicians and patients.

Why Dialysis Patients Are Particularly Vulnerable to Infections

Dialysis involves frequent removal and return of blood through vascular access, typically an arteriovenous (AV) fistula, AV graft or central line catheter. These access points are necessary but can provide a route for germs to enter the bloodstream. According to the U.S. Centers for Disease Control and Prevention (CDC), patients on dialysis are at high risk for bloodstream infections, with Staphylococcus aureus among the most common pathogens. Severe infections can lead to sepsis, a life-threatening immune response, and even death. 

The inherent risk is not a minor concern. Infection is a leading cause of death in dialysis patients, accounting for substantial morbidity and mortality. The HEMO Study, a major clinical trial published in 2003, found that nearly one-quarter of all deaths in hemodialysis patients were attributed to infection, highlighting how pervasive and dangerous prevention failures can be. 

Also Read: India's Chronic Kidney Disease Burden Soars To 138 Million, Second Highest Worldwide

Why Infection and Death Rates Are Higher Among Dialysis Patients

Several factors explain the increased vulnerability of dialysis patients:

• Frequent Vascular Access and Skin Breaches: Each dialysis session introduces potential entry points for bacteria or other pathogens into the bloodstream. Catheters, in particular, are associated with a much higher infection risk than surgically created AV fistulas or grafts.
• Compromised Immune Function: End-stage kidney disease itself compromises immune defenses, making it harder for patients to fight infections. This immunosuppression combined with repeated vascular access makes infections both more likely and more severe.
• Co-existing Health Conditions: Many dialysis patients also have diabetes, cardiovascular disease or malnutrition, which further weaken immune function, amplify infection risks and elevate mortality rates.
• Facility-based Risks: Infections can originate from improper hygiene, contaminated equipment, lapses in blood handling or inadequate staff training. Prompt and rigorous infection control practices are therefore essential to protect this vulnerable population.

Infection-Related Mortality: What Research Shows

Large cohort studies reinforce that dialysis patients experience far higher rates of infection-related death than the general population. A retrospective analysis of dialysis patients in Australia and New Zealand found that infection was responsible for about 12 % of total deaths, with infection-related mortality rates still dramatically higher than in people not on dialysis. 

Global data from CDC analysis also show that dialysis patients faced elevated risks during the COVID-19 pandemic, with infection rates and COVID-related mortality higher among those receiving maintenance dialysis than the general population. This underscores how susceptible these individuals are during outbreaks of transmissible diseases and the importance of vaccination and preventive measures. 

Also Read: 7 Early Signs Of Kidney Disease That Should Not Be Ignored

The Kerala Case: A Tragic Example

In the Haripad incident, patients reported symptoms consistent with severe infection, like fever, vomiting and shivering, shortly after dialysis, according to family members. According to PTI reports, the deaths were reported to police, and an FIR was registered against hospital staff and administrators under sections of the Indian Penal Code related to acts endangering life by negligence.

The case has prompted health authorities to investigate clinical practices, hygiene standards and equipment functioning in the dialysis unit. This underscores how crucial strict adherence to infection prevention protocols is in all dialysis settings, particularly in busy public hospitals where large numbers of vulnerable patients are treated.

Patients on dialysis face significantly heightened risks of infection and death, owing to the nature of treatment, compromised immunity and the potential for lapses in care. Research consistently shows infection as a leading cause of mortality in dialysis populations, second only to cardiovascular complications. Effective prevention hinges on stringent infection control, best practices in vascular access, ongoing staff training and vigilant clinical oversight. The recent tragedy in Kerala highlights the real-world consequences when these safeguards fail. Strengthening systems to protect dialysis patients isn't just a clinical imperative, it's a public health priority.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.