Ermal LikajUniversity Hospital Center “Mother Theresa”, Albania
Title: Surgical treatment of infective endocarditis in hemodialysis patients
Patients who have chronic kidney disease or are receiving dialysis therapy are at high risk of infection, related hospitalization, and mortality. IE in patients receiving chronic hemodialysis is a very frequent occurrence. Infective endocarditis (IE) is a life-threatening infection that contributes to significant morbidity and death in patients undergoing dialysis. Compared with the general population, patients undergoing dialysis are more vulnerable to IE because of their impaired immunity, high prevalence of periodontal disorders, frequent vascular cannulation, and repetitive exposure to non-physiologic dialysates. The diagnosis is complex and its presence should be considered in all hemodialysis patients with bacteremia. Among the general population, surgical indications for IE are clear with a moderate level of evidence. In patients on dialysis, however, the level of evidence is low, and recommendations are weak. Patients undergoing dialysis have more comorbidities and higher perioperative complication risks than the general population. The Society of Thoracic Surgery score and EURO score both incorporate kidney function. Impaired kidney function or dialysis is a strong predictor of short-term mortality. Because of the high perioperative risk, patients on dialysis who develop IE undergo surgical intervention less frequently than patients with IE and without kidney diseases. Thus, evidence to support the benefit of surgery in such patients is lacking, and the decision regarding whether to perform surgery to treat IE continues to be made on a case-by-case basis.