Data show that Black and Hispanic patients on dialysis in the U.S. have higher risks of developing staph bloodstream infections than their white counterparts, federal health officials say, adding that reducing inequalities can save lives.
A report released Monday by the Centers for Disease Control and Prevention sheds light on the risks and disparities associated with dialysis for end-stage kidney disease, in which a machine does the work of those organs by removing waste and excess fluid from blood.
"More than half of people in the U.S. receiving dialysis belong to a racial or ethnic minority group — about 1 in every 3 people receiving dialysis is Black and 1 in every 5 is Hispanic," the CDC said in a release. "CDC data found patients on dialysis in these groups have higher rates of staph bloodstream infections than White patients on dialysis."
Dialysis treatment is necessary for individuals whose kidneys are failing — often as the result of high blood pressure, diabetes, lupus or other conditions — but comes with risks, the CDC says.
Because patients are connected to the machines with needles or catheters, Staphylococcus and other bacteria can enter their bloodstream. Dialysis facilities reported more than 14,000 bloodstream infections to a national tracking system in 2020, 34% of which were due to staph. Some 560,000 Americans with end-stage kidney disease received dialysis that year.
Some staph infections are resistant to the antibiotics commonly used to treat them, and can be deadly.
Between 2017 and 2020, the CDC found that adults on dialysis for end-stage kidney disease were 100 times more likely to have a staph bloodstream infection than adults who did not receive the treatment. Hispanic patients had a 40% higher risk of those infections than white patients during that period.
After adjusting for age, sex and other factors, the study concludes that Hispanic patients and those between 18-49 years old face the highest risk, as do people living in areas with higher poverty, household crowding and lower education.
The CDC outlined other common challenges for many patients on dialysis, including lack of access to preventive care for conditions like diabetes and high blood pressure and lack of patient education about treatment options for end-stage kidney disease.
The unadjusted rate of staph bloodstream infections among Black patients was 23% higher than white patients, but when the CDC adjusted for other factors the rate was not statistically significant, CNBC reports.
"It is still important to highlight these elevated rates because staph bloodstream infections do occur at a higher rate in Black patients on dialysis but there are other factors that contribute to this elevated rate outside of race alone," CDC spokesperson Martha Sharan told the outlet.
There is some encouraging news, however: Bloodstream infections in dialysis patients have decreased since 2014, and there are steps that patients and healthcare providers can take to try to avoid them.
"Dialysis-associated bloodstream infections are preventable — not inevitable," said Dr. Shannon Novosad, the dialysis safety team lead at the CDC's Division of Healthcare Quality Promotion.
What public health and healthcare professionals can do
The CDC says the best way to prevent staph bloodstream infections is by detecting chronic kidney disease early enough to put patients needing dialysis at all.
"Healthcare 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," says CDC Chief Medical Officer Debra Houry.
The report stresses the importance of reducing barriers to healthcare by offering transportation assistance, insurance coverage expertise, social work services and educational resources in multiple languages.
While chronic kidney disease is generally irreversible, certain nutritional, lifestyle and medical interventions may help slow its progression. Those include limiting sodium, quitting smoking and improving blood pressure control.
When dialysis is necessary, the CDC says providers should prioritize methods that pose a lower infection risk, including using proven infection prevention and control practices. That could also mean using fistulas or grafts instead of higher-risk catheters.
"Education and implementation of established best practices to prevent bloodstream infections are critical to protecting the entire [dialysis] patient community," the study concludes, "including those most at risk."