Febrile reactions are defined as a rise in temperature during HD of at least 0.5° C or a rectal or axillary temperature during dialysis of at least 38.0 or 37.5° C respectively¹.  The majority (70%) of febrile reactions are associated with preexisting infections (vascular access, urinary and respiratory)^1,2.

HD related febrile reactions can be associated with localized infection of the vascular access site (especially catheters and grafts) or products from the dialysate and/or the apparatus used for HD treatment³

Diagnosis and Treatment

• Obtain blood cultures
• Begin broad spectrum antibiotics immediately
• Treatment largely supportive and empirical
• Cluster of similar cases should prompt a review of:
  • Water used for reprocessing
  • Dialysate
  • Processing procedure
  • Bicarbonate system⁴

Prevention

• Reduce the use of catheters for HD
• Reduce the susceptibility to infections by:
  • Provide adequate HD
  • Prevent and/or treat malnutrition
  • Optimize hemoglobin concentration
  • Avoid iron overload
• Use biocompatible dialysis membrane⁵
• Reduce S. aureus infections by screening nasal carriers and treating with mupirocin or gentamicin topically⁵

 References:

1. Evers J. Approach to fever in dialysis patients. Nephron 69:110, 1995
2. Gaynes R, Fridman C, Foley MK, Swartz R. Hemodialysis-associated febrile episodes: Surveillance before and after major alteration in the water treatment system. Int J Artif Organs. 13:482-487, 1990.
3. Beck-Sague CM, Jarvis WR, Bland LA, Aruino MA, Aguero SM, Verosic G. Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am J Nephrol 10:397-403, 1990
4. Duffy R, Tomashek K, Spangenberg M, Spry L, Dwyer D, Safranek TJ, Ying C, Portesi D, Divan H, Kobrenski J, Arduino M, Tokars J, Jarvis W. Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets. Kidney Int 57:1668-1674, 2000
5. The EBPG Expert Group on Haemodialysis. Hemodialysis-associated infection. Nephrol Dial Transplant 17:S72-S87, 2002