An immunocompromised dialysis patient with skin and bone lesions

Patients with chronic kidney failure have disturbances of immune function involving both innate and adaptive systems. These result in both immunodepression which increases susceptibility to infection and immunoactivation leading to a chronic inflammatory state [1]. Dialysis treatment may further aggravate aspects of this, especially the induction of inflammation. In addition, there is a growing number of patients who have returned to dialysis programmes following transplant failure. Many of these will have been intensively immunosuppressed, often over years or decades. These patients are at particular risk.