HAEMODIALYSIS CATHETER UTILISATION IN NEW ZEALAND: REPORT FROM THE REDUCCTION TRIAL
JAYSON CATIWA1,2, SRADHA KOTWAL1,3, MARTIN GALLAGHER1,4, ALAN CASS5, SHAREN SUPERSHAD6, DAVID SEMPLE7,8 1The George Institute for Global Health, Newtown, NSW, Australia2St George Hospital, Kogarah, NSW, Australia3Prince of Wales Hospital, University of New South Wales, Randwick, NSW, Australia4South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia5Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia6Northland District Health Board, Whangarei, New Zealand7Department of Renal Medicine, Te Whatu Ora Te Toka Tumai Auckland, Auckland, New Zealand8Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
Abstract
Aim
To describe the incidence and outcomes of haemodialysis (HD) catheters in New Zealand (NZ) from the observational data collected for the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.
Background
Nearly 80% of the incident HD population in NZ in 2018 was catheter-dependent, however, HD catheter use and the subsequent outcomes remain poorly understood.
Methods
All adults under the care of a participating site with a new HD catheter inserted from August 2018 to March 2020 were included. The primary outcome was the confirmed HD catheter-related bacteraemia (CRB) rate. A subgroup analysis was conducted to identify predictors for HD-CRB development.
Results
From 894 incident patients, 1,337 HD catheters were inserted across 6 NZ sites within the 17-month data collection period, corresponding to 157,142 catheter days. Majority of HD patients were male, median age of 58 and of Māori descent. Over 70% of catheters were tunnelled into the right internal jugular vein in radiology, mainly for initial HD without a permanent access (41%). The crude HD-CRB rate was 0.42 episodes/1000 catheter days with an average of 97 days from insertion date to first infection. Staphylococcus aureus was the most common HD-CRB pathogen. Older age and tunnelled catheters were independent protective factors for HD-CRB after adjusting for other predictors (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.94, 0.99, P-value 0.001 and OR 0.07 95% CI 0.02, 0.25, P-value <0.001, respectively).
Conclusion
This is the first NZ data that describes the utilisation patterns of HD catheters and investigated the risk factors that influenced HD-CRB, which may inform future interventions targeted to reduce the incidence of HD-CRB in NZ and improve patient outcomes.
Biography
Jayson is a Clinical Nurse Consultant for Dialysis Access at a large tertiary teaching hospital in Sydney. Jayson is a seasoned haemodialysis clinician with over 13 years of renal nursing experience locally and internationally. He is also a Research Coordinator at Fresenius Kidney Care, Australia & New Zealand, a global kidney service provider. His expertise includes vascular access coordination, vein preservation, and point-of-care ultrasound use in arteriovenous access cannulation. Jayson is dedicated to advancing the field of renal nursing through evidence-based practice and innovative approaches. His multifaceted role allows him to contribute to the field from multiple perspectives, driven by his passion for optimising patient outcomes.