Kidney Disease And Sepsis: How Are These Two Related?

What is Sepsis?

Sepsis is a fatal medical emergency condition caused as a body’s extreme response to any infection⁽¹⁾. Without immediate treatment, sepsis can cause organ failure, tissue damage and even death.  When there is an infection in the body, the immune system will try to fight it. However, sometimes it is unable to fight the infection and it causes damage to the normal organs and tissues leading to inflammation spreading all over the body.

Sepsis also triggers inflammation in the body and this increases the risk of kidney failure, which in turn can further weaken the immune system and increases the risk of sepsis. Any type of infection can cause sepsis⁽¹⁾.

The inflammation caused by sepsis in the body can lead to multiple organ failure. Sepsis is thought to be most common risk factor for acute kidney failure and is seen in around 26% to 50% of individuals having acute kidney failure, which is a condition where there is sudden loss of kidney function⁽²⁾.

Kidney failure can also increase the risk of having sepsis. Individuals having kidney failure commonly have weak immune system, which increases their risk of infections.

How are Kidney Disease and Sepsis Related?

Sepsis can cause acute kidney failure and kidney failure can increase the risk of sepsis. Read on to understand how these two are linked.

Sepsis Can Cause Acute Kidney Failure

Sepsis is the leading cause of acute kidney failure in individuals who are critically ill⁽⁴⁾. It is possible to reverse acute kidney failure; however, there is always a risk of long-term kidney complications.

Experts are still studying as to exactly why sepsis can cause kidney injury⁽³⁾. The theory is that the following have a role in causing kidney failure⁽³⁾:

• Dysfunction of small blood vessels.
• Inflammation in the body.
• Metabolic reprogramming where the body chooses sugars instead of fat as its main source of energy leading to energy shortage⁽⁴⁾.
• Individuals having sepsis will likely have more severe acute kidney failure than individuals having kidney failure without the sepsis⁽²⁾. People having sepsis and kidney failure will also have increased risk of dying from kidney failure.

Having a Kidney Disease Increases the Risk of Sepsis

Individuals having kidney disease will also have a weak immune system and this increases the risk of developing sepsis and also increases the risk of developing a blood infection.

Kidney Disease and Your Immune System

Individuals having chronic kidney disease commonly also have weak immune system due to the accumulation of toxins in the blood which do not get filtered properly.

Dialysis and Blood Infections

Individuals who are on dialysis have a vascular access site where a thin tube (catheter) or graft is inserted into the blood vessel and this vascular access site can be an entry way for bacteria into the bloodstream and increases the risk of developing sepsis. It was found that more than 14,000 bloodstream infections were seen in patients who were on dialysis in the year 2020 in United States⁽⁵⁾. The risk of infection depends on the type of vascular access site the patient has.

A large study done in 2020 on greater than 870 000 people revealed that around 30% of individuals who were on hemodialysis in America from the year of 2006 to 2014 had sepsis at a mean follow-up of 1.64 years. Individuals having grafts and catheters had a significantly increased risk than individuals with fistulas. One of the most common types of dialysis is hemodialysis.

What are the Symptoms of Sepsis and Acute Kidney Disease?

Acute kidney failure and sepsis are both medical emergencies and need immediate emergency medical attention. If you see someone having the symptoms of any of the two, then call 911 or local emergency services immediately.  Symptoms of sepsis in adults consist of: slurred speech, confusion, rapid breathing, and difficulty in breathing, having a persistent rash; gray, blue or blotchy skin, lips or tongue; fever, feeling cold or shivering; sweaty and clammy skin and extreme pain.

The symptoms of sepsis in children are:

• The babies are sleepier than usual.
• They do not feed or respond normally.
• They have an abnormally high-pitched and weak cry. 

What are the Symptoms of Acute Kidney Failure?

Symptoms of acute kidney failure often develop within hours to days and consist of: drowsiness, diarrhea, confusion, reduced urine output and dehydration. 

What is the Treatment for Sepsis and Kidney Disease?

Treatment for acute kidney failure and sepsis consists of urgent care in a hospital where the patient is closely monitored by the doctors and specialists to prevent any fatal complications. Treatment mostly involves treating the underlying infection and managing the symptoms.

Treatment for Sepsis and Kidney Disease can include:

Antibiotics are given to assist the body in fighting any bacterial infections. For each hour the antibiotics are not given, there is an associated 8% increased risk of death in patients having sepsis and acute kidney failure.

Antivirals are given for viral infections.

Intravenous fluids are given to prevent dehydration or kidney failure.

Oxygen is given through a tube or mask to increase the oxygen levels that are present in the blood.

Blood pressure medications, such as vasopressors, are given to increase the blood pressure if it drops to dangerously low levels.

Other medications that are given are for:  preventing blood clots; balancing the blood sugar; preventing other complications and for controlling the potassium and calcium levels.

Dialysis: If acute kidney failure has occurred as a result of sepsis, then dialysis is needed to decrease the levels of the increased toxic chemicals in the blood, which do not get filtered by the kidneys because of kidney failure.

How Serious Is Sepsis With Kidney Failure?

Sepsis along with acute kidney failure can be a potentially life threatening condition especially if immediate treatment is not done, then it can lead to multiple organ failure and death.

A study from 2022 found that death rate among 1,122 patients having sepsis was about 16.59%; however, the mortality rate increased to 25.68% in individuals who also suffered from kidney failure⁽⁶⁾. Patients on dialysis are at 30 to 50 times at increased risk of dying from sepsis than patients who are not on dialysis⁽⁷⁾. 

Can one survive Sepsis with Kidney Failure?

Yes, one can survive sepsis with kidney failure, providing that the patient is given immediate medical attention. A study from 2018 found evidence that individuals who recovered from acute kidney failure and sepsis by the time they are discharged from the hospital have similar long-term survival as individuals who have recovered from sepsis without kidney failure⁽⁸⁾.

Some patients can make complete recovery from sepsis. The duration it takes to recover depends on some factors like:

• The patient’s general health.
• The severity of the sepsis in the body.
• If the treatment was given in an intensive care unit (ICU).
• The duration of hospital stay.

Acute kidney failure can cause lifelong complications, such as chronic kidney disease. A study from 2022 showed that patients who were discharged from the hospital with sepsis were at greater risk for having kidney problems⁽⁹⁾.

Conclusion

Sepsis is a fatal condition caused by the body’s immune system response to an infection. A common complication of sepsis is acute kidney failure and both of these conditions need immediate and urgent medical attention.

Individuals having kidney disease also are at increased risk for developing sepsis because of frequently suffering from weakened immune system and also having an increased risk of blood infection related to dialysis.

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Also Read:

• What are the Serious & Long Term Effects of Sepsis?
• What are the Serious & Long Term Effects of Sepsis?
• Neonatal Sepsis: How Common is it and What is its Treatment?