From the Research
End-stage renal disease (ESRD) patients experiencing random low-grade fevers should be promptly evaluated for potential causes, with infection being the most common culprit, and managed accordingly to prevent morbidity and mortality. The evaluation of ESRD patients with low-grade fevers is crucial due to their compromised immune systems, which make them more susceptible to infections 1. Infections may occur at dialysis access sites, such as catheters, fistulas, or grafts, in the urinary tract, lungs, or bloodstream. Other potential causes of low-grade fevers in ESRD patients include:
- Dialysis-related complications, such as dialyzer reactions or contaminated dialysate
- Inflammatory conditions associated with ESRD, such as pericarditis, inflammatory arthritis, or vasculitis
- Medications commonly used in ESRD patients, including erythropoietin-stimulating agents or antibiotics, which can induce drug fevers
- Underlying malignancies, which occur at higher rates in ESRD patients and may present with persistent low-grade fevers
Diagnostic workup typically includes:
- Blood cultures
- Urine cultures (if the patient still produces urine)
- Chest X-ray
- Examination of dialysis access sites
Treatment depends on the identified cause but may include antibiotics for infections, medication adjustments, or addressing dialysis-related issues 2. It is essential to note that ESRD patients are at a higher risk of developing antibiotic-resistant infections, such as those caused by Pseudomonas aeruginosa or Staphylococcus aureus, which require prompt and effective treatment 3, 4. Therefore, ESRD patients with unexplained fevers should be managed with caution, and their healthcare providers should be aware of the potential causes and treatment options to prevent morbidity and mortality.