Kidney Disease and Sepsis: How One Can Lead to the Other

Sepsis can lead to acute kidney failure, and kidney failure may increase your risk of sepsis. Here’s a look at how the two are related.

Sepsis can cause acute kidney failure

Sepsis is the leading cause of acute kidney failure in people who are critically ill. Acute kidney failure can often be reversed, but it also puts you at risk of long-term kidney complications.

Researchers are still investigating exactly why sepsis leads to kidney injury. Most of what’s known comes from animal research or autopsy studies. Factors theorized to play a role include:

• inflammation
• dysfunction of small blood vessels
• metabolic reprogramming where your body prioritizes sugars over fat as its main energy source, which can lead to an “energy shortage”

People with sepsis tend to have more severe acute kidney failure than people with kidney failure who don’t have sepsis. They also have a higher risk of dying from kidney failure.

Kidney disease puts you at risk of sepsis

Having kidney disease can put you at risk of developing sepsis by weakening your immune system and increasing your chances of developing a blood infection.

Kidney disease and your immune system

People with chronic kidney disease often have weakened immune systems. This largely occurs due to the collection of toxins in the blood that aren’t properly filtered.

Dialysis and blood infections

People on dialysis have a vascular access site where a catheter (thin tube) or graft is inserted into a blood vessel. Having a vascular access site can introduce bacteria into your bloodstream and put you at risk of developing sepsis. More than 14,000 bloodstream infections occurred in people on dialysis in the United States in 2020.

Your risk of infection depends on which type of vascular access site you have.

In a large 2020 study of more than 870 000 people, researchers found that about 30% of people on hemodialysis in the United States from 2006 to 2014 developed sepsis at an average follow-up of 1.64 years. People with catheters and grafts had a significantly higher risk than people with fistulas. Hemodialysis is the most common type of dialysis.

Sepsis and acute kidney failure are both medical emergencies. It’s important to get immediate emergency medical attention. Call 911 or local emergency services if you or somebody you’re with has symptoms of either condition.

Sepsis

Symptoms of sepsis in adults can include:

• confusion, slurred speech, incoherence
• difficulty breathing or breathing very fast
• a rash that doesn’t fade if you roll a glass over it
• blue, gray, or blotchy skin, tongue, or lips (people with dark skin may be able to better see discoloration on their palms or soles of their feet)
• fever, shivering, or feeling cold
• clammy or sweaty skin
• extreme pain

In babies or young children, you may also notice that they:

• are sleepier than normal
• don’t respond or feed normally
• have a weak and abnormally high-pitched cry

Symptoms of acute kidney failure

Symptoms of acute kidney failure usually appear within hours to days and can include:

• diarrhea
• drowsiness
• a lower urine output than normal
• dehydration
• confusion

Treatment for sepsis and acute kidney failure requires urgent care in a hospital where doctors or healthcare professionals can closely monitor you to prevent life threatening complications. Treatment largely involves treating the underlying infection and managing your symptoms.

Treatment may include:

• Antibiotics: Antibiotics help your body fight off bacterial infections. Every hour that antibiotics are delayed is associated with an 8% increased risk of death in people with sepsis and acute kidney failure.
• Antivirals: Antibiotics aren’t effective for viral infections, so you may be given antiviral drugs instead. Antibiotics are usually administered when the cause isn’t known.
• Fluids: Fluids administered through an intravenous (IV) line can help prevent dehydration or kidney failure.
• Oxygen: You may be given oxygen through a mask or tube to raise the levels of oxygen circulating in your blood.
• Blood pressure medications: You may receive vasopressors to raise your blood pressure if your blood pressure drops dangerously low.
• Other medications: Your medical team may also administer medications to:
  • balance your blood sugar
  • prevent blood clots
  • prevent other complications
  • control your levels of potassium and calcium
• Dialysis: If sepsis has caused acute kidney failure, you may need dialysis to reduce levels of toxic chemicals elevated too high in your blood that are normally filtered by your kidneys.

Sepsis with acute kidney failure is potentially life threatening. If not treated right away, it can lead to multiple organ failure and death.

In a 2022 study, researchers found that the mortality rate among 1,122 people with sepsis was 16.59% but that the mortality rate rose to 25.68% in people who also had kidney failure.

People on dialysis have a 30 to 50 times higher risk of dying from sepsis than people not on dialysis.

Yes, you can survive sepsis with kidney failure, but quick medical attention is essential.

In a 2018 study, researchers found evidence that people who recover from acute kidney failure and sepsis by the time they’re released from the hospital have similar long-term survival as people who recover from sepsis without kidney failure.

Some people can make a full recovery from sepsis. The amount of time it takes to recover depends on factors such as:

• the severity of your sepsis
• your overall health
• how long you’re in the hospital
• whether you receive treatment in an intensive care unit (ICU)

Acute kidney failure can lead to lifelong complications including chronic kidney disease.

In a 2022 study, researchers found that people discharged from the hospital with sepsis were at a significantly higher risk of subsequent kidney problems.

Sepsis is a life threatening condition caused by your immune system’s reaction to an infection. Acute kidney failure is a common complication of sepsis. Both conditions require immediate emergency medical attention.

People with kidney disease are also at an elevated risk of developing sepsis due to frequently having weakened immune systems and having a high risk of blood infection associated with dialysis.