From the Guidelines
Chills after hemodialysis are a serious symptom that requires immediate medical attention, as they may indicate a life-threatening infection such as bacteremia, which can lead to sepsis and death if not promptly treated with antibiotics like vancomycin or ceftazidime, as recommended by the Infectious Diseases Society of America 1.
Causes of Chills
The most concerning cause of chills after hemodialysis is bacteremia, which is an infection of the bloodstream that can be caused by bacteria such as Staphylococcus aureus, Pseudomonas species, or Candida species, as noted in the KDOQI clinical practice guideline for vascular access 1. Other causes of chills include:
- Rapid fluid or temperature changes during dialysis
- Reactions to the dialyzer
- Infections of the catheter site, such as exit site infections or tunnel infections
Treatment of Chills
Treatment of chills after hemodialysis depends on the cause of the symptom. If the cause is an infection, antibiotics such as vancomycin or ceftazidime may be prescribed, as recommended by the Infectious Diseases Society of America 1. If the cause is a dialysis-related reaction, adjustments to the dialysis prescription may be necessary, such as changing the dialysate temperature or slowing the ultrafiltration rate.
Prevention of Chills
To prevent chills after hemodialysis, it is essential to:
- Maintain strict catheter care if you have a catheter
- Ensure proper hand hygiene before accessing your fistula or graft
- Communicate with your healthcare team about any symptoms you are experiencing
- Follow the recommendations for water treatment in the outpatient dialysis unit, as outlined in the American Journal of Kidney Diseases 1
Importance of Prompt Medical Attention
Prompt medical attention is crucial if you experience chills after hemodialysis, as delaying treatment can lead to serious complications, including sepsis and death. The dialysis team should check your temperature, blood pressure, and possibly draw blood cultures to determine the cause of the chills and provide appropriate treatment, as recommended by the KDOQI clinical practice guideline for vascular access 1.
From the Research
Chills after Hemodialysis
- Chills are a common complication in patients undergoing hemodialysis, with a high rate of infection, approximately 60% 2.
- The risk factors for bacteremia in hemodialysis patients presenting with chills include fever, vascular catheter as dialysis access, and leukocytosis 2.
- Patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, have a low risk of bacteremia and may be investigated without prompt antibiotic treatment 2.
- Procalcitonin levels can be used to discriminate severe bacterial infections from non-bacterial causes of fever or chills in chronic dialysis patients, with a cutoff value of 1 ng/ml or higher having 77% sensitivity and 59% specificity for the diagnosis of severe infection 3.
Infection Prevention and Management
- Vascular access-related infections are the most common identifiable source of infection in hemodialysis patients, with Staphylococcus aureus, coagulase-negative Staphylococci, and Enterococci being the most common causative microorganisms 4.
- Preventive measures for bloodstream infections in hemodialysis patients include avoidance of central venous catheters, best practices for catheter care, surveillance, antimicrobial catheter lock solutions, and use of antibiotic-impregnated catheters 4, 5.
- The Centers for Disease Control and Prevention (CDC) core interventions for bloodstream infection prevention are the gold standard for catheter care in the hemodialysis setting and have been proven to be effective in reducing catheter-associated bloodstream infection 5.
- Post-dialysis treatment with intravenous antibiotics, such as cefepime, can be effective in managing infections in hemodialysis patients, with a fixed dose of 1 g before every 48-h interval and 1.5 g before every 72-h interval recommended for patients infected by highly susceptible pathogens 6.