Long-term complications of dialysis: infection.

It is widely accepted that patients with renal failure have an increased risk of infection. Laboratory studies have established defects in cellular immunity, neutrophil function and complement activation. Clinical studies undertaken almost a quarter of a century ago indicated that infection caused or contributed to 30% of deaths in patients on long-term hemodialysis. Apart from infection related to access, however, current evidence indicates that serious infections are not common in patients who are on either maintenance hemodialysis or continuous ambulatory peritoneal dialysis and are associated with a mortality rate of less than 3%. Despite the depressed immune response associated with uremia, it would thus appear that patients on maintenance dialysis therapy do not have significantly increased morbidity or mortality from infectious diseases with the exception of those related to dialysis access.