Black, Hispanic Dialysis Patients at Higher Risk for Staph Infection

And thank you for standing by. At this time all participants are in a listen only mode until the question answer portion of today’s conference. At that time, if you would like to ask a question, please dial star zero. Excuse me, please dial star one. This call is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the conference over to Benjamin Haynes. Thank you. You may begin.

Benjamin Haynes


Thank you, Madison. And thank you all for joining us today for the release of a new CDC Vital Signs. We are joined today by Dr. Deborah Houry CDC’s Chief Medical Officer, and Dr. Shannon Novosad, team lead for the Dialysis Safety Team in CDC’s Division of Healthcare Quality and Promotion. Please note that today’s briefing is embargoed until 1pm. Eastern when our Vital Signs is live on the CDC website. I’ll now turn the call over to Dr. Houry.

Debra Houry


Good afternoon, everyone. Thank you for joining us today. CDC is unwavering in its commitment to equitably protect the health, safety, and security of all Americans against all threats as we begin 2023, this month, CDC Vital Signs report focuses on the threat of serious bloodstream infections and people on dialysis. More than 800,000 people in the United States live with end-stage kidney disease. 70% of these patients are treated with dialysis. And more than half of all U.S. patients who are receiving dialysis belong to a racial or ethnic minority group. CDC Vital Signs spotlights serious health threats like staph bloodstream infections in people on dialysis, and the science-based actions that can be taken to curb these threats.

The kidneys have a key role in cleaning our blood by filtering waste and toxins and eliminating excess fluid from our bodies through urine. However, certain medical conditions like diabetes and high blood pressure can lead to chronic kidney disease, which is the gradual loss of kidney function where the kidneys can no longer clean the blood effectively. This can then progress to end-stage kidney disease. That’s why it is essential for health care providers to promote practices to prevent and manage medical conditions like diabetes and high blood pressure. Unfortunately, many people lack access to such preventive care, particularly Black and Hispanic people— for a variety of reasons. This increases their risk of developing end-stage kidney disease. There are several treatments for end stage kidney disease, including kidney transplants, peritoneal dialysis and hemodialysis. Our Vital Signs report focuses on hemodialysis, a treatment to filter waste, and water from the blood hemodialysis treatment is usually done in an outpatient dialysis facility and requires the use of needles or catheters to connect a patient’s blood circulation to the dialysis machine. The machine filters toxins from the blood and then returns it to the patient. Germs like staph can get into the patient’s bloodstream via these access points. These infections can be serious or deadly, and some are resistant to some of the most common antibiotics used to treat them. In the emergency department all too often I saw patients who didn’t have access to regular dialysis treatments and had to wait each time until they were in kidney failure to get emergency dialysis. The patients will come in very sick and short of breath and after dialysis, we’re able to return home. Preventing infections among patients receiving dialysis requires a comprehensive, equitable approach across the stages of kidney disease from prevention to care. We need to encourage practices such as physical activity and healthy eating to slow the progression of chronic kidney disease and help control blood pressure and blood sugar levels. Take proven actions to prevent and control infections in dialysis facilities. Educate patients about the infection risks of the different ways blood circulation is connected to the dialysis machine or vascular access types and empower patients to ask questions. And finally, we need to reduce barriers to receiving medical care. Equitable access to health care can help us identify risks for kidney disease sooner and help people avoid dialysis altogether. Now I’ll turn it over to Dr. Shannon Novosad who will talk more about infection prevention and highlight the findings of today’s Vital Signs Report.

Shannon Novosad


Thank you, Dr. Houry. Today’s Vital Signs report highlights important disparities in bloodstream infections among patients on dialysis. Dialysis treatment puts people at risk for bloodstream infection our analysis shows adults on dialysis in the U.S. were 100 times more likely to have a staph bloodstream infection than other adults in the general population. As we looked at data from 2017 to 2020, we also found that Black and Hispanic patients on dialysis had higher rates of staph bloodstream infections than White patients on dialysis. And when looking at counts of bloodstream infections, more patients on dialysis with staph bloodstream infections lived in areas with higher poverty, more household crowding, and lower education levels. For example, 42% of dialysis staph bloodstream infections occurred in areas with highest poverty levels, versus 10% in areas with lowest poverty levels. These infections are preventable and understanding these differences can help the dialysis community to focus interventions at different points along the spectrum of kidney disease care and prevention. The encouraging news is that we have seen a decrease in dialysis bloodstream infections from the increasing use of proven practices to prevent and control infections. There are three types of vascular access that are used to connect a patient’s blood circulation to the dialysis machine, fistula, graft, and central venous catheter. Vascular access type is a well-known risk factor for bloodstream infections and our data confirm this. Use of a central venous catheter as a vascular access type has six times higher risk for staph bloodstream infections compared with the, lowest risk fistula access. People with any access type can develop an infection, but fistulas have the lowest risk of infection, and central venous catheters have the highest risk of infection. As opposed to fistulas and graph, a central venous catheter involves putting a tube through the skin into a vein in the neck, chest, or groin. The end of the tube inside the body stops near the heart, and the other end remains outside of the body, exposed to germs which can adhere to the tube and move into the bloodstream. So what can be done? Removing barriers to lower-risk vascular access types for dialysis treatment is a critical step for preventing infections. It is vital to coordinate efforts among patients, nephrologists, vascular access surgeons, radiologists, nurses, nurse practitioners, and social workers to reduce the use of central venous catheters for dialysis treatment. It’s also critical to educate patients on potential treatment options, and vascular access types before they develop end-stage kidney disease. We can encourage practices to prevent and slow the progression of chronic kidney disease, particularly in areas of lower socioeconomic status. We can apply proven practices to prevent and control infections in all U.S. dialysis facilities. Finally, we can work toward reducing barriers for patients receiving medical care by offering transportation assistance, insurance coverage, expertise, and social work services. It is important that all these proven actions include patient education materials that are culturally appropriate and in the patient’s preferred language. This may be especially relevant for Hispanic patients, given the higher staph bloodstream infection risks observed in Hispanic people. I do want to recognize that many dialysis providers are making these efforts and CDC is committed to supporting them. And now I will turn it back over to Dr. Houry.

Dr. Houry


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