Chills During Hemodialysis: Prediction and Prevalence of Bacterial Infections - A Retrospective Cohort Study.

Introduction: Chills are a complication of patients undergoing hemodialysis. The rate of infection among hemodialysis patients presenting with chills is not well established, and empirical broad-spectrum antibiotics are usually the rule.

Methods: We performed a retrospective study aiming to assess the rates of infection and bacteremia in hemodialysis patients presenting with chills. We evaluated risk factors for infection and bacteremia and tested a prediction model for infection.

Results: Overall, 269 hemodialysis patients with a first episode of chills were included. Ninety patients (33.5%) had bacteremia and 162 (60.2%) had an infection. Risk factors for bacteremia in multivariate analysis included fever (odds ratio [OR] 1.6; 95% confidence interval [CI], 1.1-2.3; P = .009) and vascular catheter as dialysis access (OR 6.2; 95% CI, 3.2-12.0, P <.001). Leukocytosis was an additional risk factor in multivariate analysis for any type of infection (OR 1.265; 95% CI, 1.113-1.438; P <.001). Using a prediction model to evaluate patients without obvious source of infection, we found that patients with fistula or graft as their access, without fever, abnormal leukocytes, or hypoalbuminemia, had a low rate (1/17, 6%) of bacteremia.

Conclusions: Hemodialysis patients presenting with chills during dialysis, with or without fever, have high rates (∼60%) of infection. Patients with no obvious source of infection, with fistula or graft as access, presenting without fever, leukocytosis, or hypoalbuminemia have low risk for bacteremia and may be investigated without prompt antibiotic treatment. All other patients should receive antibiotic coverage immediately following a chills episode.