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After cardiovascular causes, infectious diseases are the next most common cause of death for dialysis patients. The Japanese Society for Dialysis Therapy reported an increased standardized mortality of 7.5-fold [95% confidence limits (CI) 7.3–7.6] for infectious diseases between 2008 and 2009 compared with the general Japanese population. The increased mortality rates for dialysis patients were greatest for sepsis, followed in descending order by peritonitis, influenza, tuberculosis and pneumonia [1]. Patients with chronic kidney disease are more susceptible to some infections, as the azotaemic state alters innate immunity, with reports of reduced monocyte Toll-like receptor 4 expression [2], reduced B-lymphocyte cell populations [3] and impaired polymorphonuclear chemotaxis and phagocytosis [4]. It has also been proposed that changes in the gastrointestinal microbiota, and increased intestinal permeability to endotoxin, lead to a persistent activation of the innate immune system, resulting in the induction of immuneregulatory mediators which then suppress both innate and adaptive immunity [5]. Additionally, immune responses may also be impaired by poor nutritional status, malnutrition and vitamin D deficiency [6].