As a hemodialysis patient, you want to learn all you can about your treatment and what you can do to ensure your health is at its best. One important area you should know about involves infectious diseases. These are diseases that happen when harmful germs get into your body and make you ill. Kidney failure interferes with your body's natural defense system (immune system), making it easier for you to get some types of diseases through your dialysis treatments.
What types of infectious diseases should I know about?
Although there are many viruses and diseases that can affect your health, the most important ones that you should be aware of while on hemodialysis are:
- Hepatitis B
- Hepatitis C
- HIV/AIDS
Below you will find information on these diseases and how you can protect yourself from infection while on hemodialysis.
What is hepatitis B?
Hepatitis B is a virus infection that causes liver disease. Most people fight off this infection themselves, but some may progress to chronic liver disease and possibly liver cancer. Hepatitis B is spread by contact with the blood of an infected person.
You may have an increased chance of getting hepatitis B if you:
- Sex with an infected person
- Have been exposed to sharp instruments contaminated with infected blood, such as needles used for tattooing, body piercing and acupuncture
- Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- Passing from an infected mother to her baby during childbirth
- Contact with blood or open wounds or sores from an infected person
- Sharing of razors or toothbrushes from an infected person.
While it is important to know how you can get hepatitis B, you should also know that you cannot get hepatitis B from:
- Shaking hands or holding hands with someone infected with hepatitis C
- Being coughed or sneezed on
- Hugging an infected person
- Sitting next to an infected person
- Sharing spoons, forks, and other eating utensils
- Drinking water or eating food
Can I get hepatitis B through my dialysis treatment?
In the early years of dialysis, there was a danger of getting hepatitis B through exposure to the blood of an infected person at the dialysis unit. However, today the chance of getting hepatitis B through your treatment is very small because of two important advances. One of these advances is the use of strict infection control measures in dialysis units. The second improvement is the availability of a vaccination for hepatitis B.
How do you know if you have hepatitis B?
The only way to tell for sure is to have a blood test. Most people who get hepatitis B have no symptoms at all.
However, some people may have flu-like symptoms including:
- Loss of appetite
- Nausea or vomiting
- Fever
- Extreme tiredness
- Stomach or joint pain
- Yellowing of the skin or eyes, called jaundice
Some people may become carriers of hepatitis B, which means they have no symptoms but can still infect others with the disease. The carrier state may last for years or even for life. Some carriers may eventually develop scarring of the liver, liver failure or liver cancer.
Are there treatments for hepatitis B?
Yes. Your healthcare provider will choose the right combination of available medicines to help treat your symptoms and hepatitis b infection. During this time, you will be closely watched by your healthcare provider to make sure treatments are working. Treatments include:
- Interferon injection
- Peginterferon injection
There are also medicines you can take by mouth. These are:
- Adefovir
- Entecavir
- Lamivudine
- Telbivudine
- Tenofovir
These drugs do not always provide a complete cure for hepatitis B, but they do help decrease the risk of damage to your liver from a hepatitis b infection. In more serious cases, and if treatment does not work, a liver transplant may be needed.
How can hepatitis B be prevented?
One of the best ways to prevent hepatitis B is to be vaccinated. Hepatitis B vaccination is recommended for all children (including adolescents and teens) and hemodialysis patients and staff. The vaccine works by causing your body to make special proteins called antibodies that protect you against hepatitis B. Your response to the vaccine depends on your age, other medical conditions you may have and your general state of health, but most people will make enough antibodies to protect them against the disease. If you are vaccinated, your dialysis care team will check your blood to make sure enough antibodies are present. If you have not yet been vaccinated, ask your dialysis staff about the vaccination.
You can also help to prevent hepatitis B by following safe sex guidelines and by avoiding high-risk behaviors such as injecting drugs.
Some safe sex guidelines are:
- Use latex condoms to prevent the exchange of body fluids.
- Have only one sexual partner.
Is the vaccination safe?
Yes. The vaccines are made from baker's yeast and contain noninfectious particles called antigens. You cannot get hepatitis from the vaccination. These vaccines have undergone extensive clinical testing and have been used on millions of people worldwide with few side effects. However, people with acute illness or a known allergy to yeast should not be vaccinated.
Some Facts about Hepatitis C
How could I get hepatitis C?
Anyone can get infected with the hepatitis C virus. However, you may have an increased chance of getting hepatitis C if you:
- Were born between 1945-1965
- Inject illegal drugs
- Received blood transfusions or solid organ transplants before 1992
Less commonly, hepatitis C may be spread by:
- Passing from an infected mother to her baby during childbirth
- Having sex with an infected person
- Living with an infected person and sharing items such as razors and toothbrushes
- Exposure to sharp instruments that came into contact with infected blood, such as:
- Needles used for tattooing
- Needles used for body piercing
- Needles used for acupuncture
If you have to come into contact with needles, it is important that these needles be carefully cleaned and disinfected before use, or disposable needles should be used. You should always ask anyone using a needle on you if it was properly sterilized and, if possible, to use a new needle on you.
While it is important to know how you can get hepatitis C, you should also know that you cannot get hepatitis C from:
- Shaking hands or holding hands with someone infected with hepatitis C
- Being coughed or sneezed on
- Hugging an infected person
- Sitting next to an infected person
- Sharing spoons, forks, and other eating utensils
- Drinking water or eating food
What are the symptoms of hepatitis C?
For most people, hepatitis C does not cause any symptoms until it has damaged their liver. Others may have some or all of the following symptoms:
- Feeling tired
- Muscle soreness
- Upset stomach
- Stomach pain
- Fever
- Loss of appetite
- Diarrhea
- Dark-yellow urine
- Light-colored stools
- Yellowish eyes and skin (called jaundice)
It is important to see your healthcare provider right away if you have symptoms of hepatitis C.
Is hepatitis C a serious illness?
Hepatitis C is serious for some persons but not for others. Most of the people who get hepatitis C carry the virus for the rest of their lives. Most of these persons have some liver damage, but many do not feel sick from the disease. Some of those with liver damage due to hepatitis C may develop scarring of the liver and liver failure, which may take many years to develop. Others have no long‑term effects.
Can I get hepatitis C through my dialysis treatment?
The chance of getting hepatitis C through your treatment is small because of strict standard health precautions used in dialysis units today. However, there have been some reports that hepatitis C has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients. If you are a long-term hemodialysis patient, you should be tested for hepatitis C when you have your regular blood tests.
How can I prevent hepatitis C?
Right now, there is no vaccine is available for hepatitis C. However; researchers are working to develop a vaccine, and it may be available in the future. In the meantime, the following steps can help to prevent hepatitis C:
- Do not inject illegal drugs
- Do not share toothbrushes, razors or other personal care articles that might have infected blood on them
- Follow safe sex guidelines
- If you are considering getting tattoos or body piercing, make sure the tattoo artist or piercer follows good health practices such as washing hands and using disposable gloves
- Get vaccinated against hepatitis B
Some Facts about HIV
What is HIV?
HIV (human immunodeficiency virus) is a virus that infects and damages your immune system. Your immune system helps your body defend itself against infection and other disease. HIV attacks and destroys the disease-fighting cells of your immune system and leaves your body weak against infection and cancer.
How is HIV spread?
The most common ways HIV is spread from one person to another include:
- Having sex with an infected person
- Injecting illegal drugs
- Passing from an infected mother to her baby during childbirth or breastfeeding after birth
In addition, tattooing or body piercing can be a source of HIV infection if the instruments used carry infected blood. These instruments should be used once and disposed of or cleaned and sterilized thoroughly after each use.
What are the symptoms of HIV?
Many people who are infected with HIV do not have any symptoms for many years. The only way to tell for sure whether you are infected is to be tested for HIV infection. About half the people infected with HIV develop AIDS within 10 years after becoming infected. This time period is different for everyone.
The following may be warning signs of infection with HIV:
- Rapid weight loss
- Dry cough
- Continuing fever or night sweats
- Feeling very tired and run down for no reason
- Swollen lymph glands in the armpits, groin or neck
- Diarrhea that lasts for more than a week
- White spots or unusual blemishes on the tongue, in the mouth or in the throat
- Red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids
- Memory loss, depression and other neurologic symptoms.
However, you should not assume you are infected if you have any of these symptoms. The symptoms of AIDS are similar to those of many other illnesses. AIDS is a medical diagnosis made by a doctor and based on specific results from physical examination and test results.
Is there a treatment for HIV?
HIV is treated by using a combination of different drugs that help fight the symptoms and complications of HIV infection. The combination of drugs is called antiretroviral therapy (ART). Although ART is not a cure for HIV, it can help control the virus in your body. ART is recommended for all people infected with HIV. Your healthcare provider will go over the different drug classes and medicines that fall within each drug class. From this list, your healthcare provider will create a regimen (ART) for your treatment.
Other Infectious Diseases Dialysis Patients Should Know About
MRSA (Methicillin‑Resistant Staphylococci): MRSA is a type of infection that is caused by a type of bacteria called staph. Staph bacteria in a MRSA infection does not respond to many of the antibiotics use to treat staph infections. Most cases of MRSA are found in patients who are in hospitals, nursing homes or being treated with hemodialysis in centers.
To help prevent the spread of MRSA in the unit, your dialysis care team should follow the standard precautions recommended by the National Centers for Disease Control and Prevention (CDC) and be especially careful to:
- Wear clean and new gloves for performing procedures
- Gloves should be changed between each patient
- Wash their hands after touching a patient or any potentially contaminated articles and before taking care of another patient.
Some MRSA infections have been reported to be treatment failures with vancomycin, one of the drugs most commonly used to treat these infections. These are called VISA, or vancomycin intermediate‑resistant Staph aureus. A small number of these occurred in dialysis patients with hemodialysis or peritoneal dialysis catheters. In each case, the patient was receiving vancomycin for an extended period of time to treat catheter‑related infections. To help prevent these infections, the same measures used to prevent MRSA should be used.
VRE (Vancomycin‑Resistant Enterococcus): Enterococcus is a common germ found in the intestines. For many years, they were known to cause occasional infections. Drugs like penicillin and vancomycin would reliably cure them. However, in the 1980s, these germs stopped responding to treatment with vancomycin as well as many other antibiotic drugs. Like MRSA, VRE can often be spread in dialysis units and other health care settings. To decrease the spread of VRE from patient to patient, your dialysis care team should follow the standard precautions recommended by NCDC. In addition, they should dedicate the use of certain items, such as stethoscopes, blood pressure cuffs or rectal thermometers to a single patient or a group of patients who are infected with or carriers of VRE. If such devices are to be used on other patients, your dialysis care team should clean and disinfect them first.
Tuberculosis (TB): TB is a serious illness that mainly affects your lungs. TB is spread from person to person mainly through tiny droplets spread through the air by coughing and sneezing from an infected person. The number of cases of TB has increased over the past decade. Ask your doctor or nurse whether you should be screened for TB.
Preventing Infections in Dialysis Units
What standard precautions should my dialysis care team follow to prevent the spread of infections in the dialysis unit?
The National Centers for Disease Control and Prevention (CDC) have developed a set of standard precautions, which should be followed by the dialysis care team in all units. You should be aware of these precautions, and speak to the members of your care team if you have any questions about them.
Your nurse or patient care technician should do the following:
- Wear clean gowns, disposable gloves and face shields or masks and protective eyewear when starting your dialysis treatment and later when disconnecting you from the machine.
- Wear disposable gloves and face shields or masks and protective eyewear when doing any procedures involving your access.
- Change gloves after beginning a treatment, before touching any environmental surface such as dialysis machines, charts and phones, and after each patient contact.
- Wash hands when entering patient areas, before putting on gloves and after removing them.
- Clean and disinfect the treatment area between patient shifts.
- Maintain separate areas for "clean" (e.g., medication prep) and "soiled" (e.g., blood samples) items.
- Use a separate room and a dedicated dialysis machine and avoid dialyzer reuse for patients who are positive for hepatitis B.
- Do a blood test for hepatitis B and C on all new patients and do routine follow-up testing on susceptible patients.
If you are interested in obtaining a copy of the standard precautions, you can view the web site here.
Is dialyzer reuse safe?
Some units use the same dialyzer (artificial kidney) more than once on the same patient. This is generally considered safe if done properly. The dialyzer should be thoroughly cleaned and disinfected before each use. The dialyzer should be labeled carefully with the patient's name. Check the label on your dialyzer before each treatment. Dialyzer reuse should be avoided for patients who test positive for hepatitis B.
What vaccinations should dialysis patients have?
Check the following table to make sure you are up-to-date on all recommended vaccinations. Fill in the date you received each. Speak to your doctor if you have any questions about your vaccinations.
Vaccinations Recommended for Adult Hemodialysis Patients
Vaccine | Recommended |
|---|---|
| Diphtheria Tetanus (Dt) | Every 10 years |
| Measles Mumps/Rubella (MMR) | For all susceptible* patients |
| Hepatitis B | For all susceptible* patients |
| Pneumococcal (pneumonia) | Every 3-5 years |
| Meningococcal (meningitis) | If needed (in case of an epidemic) |
| Influenza (flu) | Once a year |
| Chicken pox (varicella) | Every 10 years |
