ACUTE KIDNEY INJURY OUTCOMES IN PEOPLE WITH DIALYSIS CATHETERS – SECONDARY ANALYSIS FROM A NATIONAL TRIAL.
A/Prof. Sradha Kotwal1,2, Mr Jayson Catiwa1, Prof Alan Cass3, A/Prof Nicholas Gray4,14, Prof Stephen McDonald5,6,7, Prof Kevan Polkinghorne8,9, Prof Kris Rogers10,11, Prof Girish Talaulikar12, Prof Martin Gallagher1,13, REDUCCTION Investigators
1The George Institute For Global Health, UNSW, Sydney, Australia, 2Prince of Wales Hospital, Sydney, Australia, 3Menzies School of Health Research, Charles Darwin University, Darwin, Australia, 4Sunshine Coast University Hospital, Birtinya, Australia, 5ANZDATA Registry, South Australia Health and Medical Research Institute, Adelaide, Australia, 6Adelaide Medical School, University of Adelaide, Adelaide, Australia, 7Renal Unit, Royal Adelaide Hospital, Adelaide, Australia, 8Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia, 9Departments of Nephrology & Medicine, Monash Medical Centre, Monash University, Melbourne, Australia, 10Graduate School of Health, The University of Technology Sydney, Sydney, Australia, 11School of Population Health, UNSW Sydney,, Sydney, Australia, 12Renal Services, ACT Health, Canberra, Australia, 13South Western Sydney Clinical School, UNSW, Sydney, Australia, 14University of the Sunshine Coast, Sippy Downs, Sippy Downs, Australia
Aim: To assess if the REDucing the burden of dialysis Catheter ComplicaTIONs (REDUCCTION) trial interventions reduced haemodialysis catheter related blood stream infection (HD-CRBSI) in people with a haemodialysis catheter inserted for acute kidney injury (AKI).
Background: Hospitalised adults with AKI needing dialysis using a haemodialysis catheter have very poor outcomes. The step wedged cluster randomised REDUCCTION trial tested the impact of a multi-faceted, evidence-based suite of interventions upon HD-CRBSI.
Methods: Using the REDUCCTION cohort, we examined the effect of the intervention on the service-level rate of confirmed HD-CRBSI in people with a catheter for AKI, using a multilevel Poisson regression model.
Results: Data were collected from 6,364 participants across 37 participating renal services, with 3588 participants receiving a catheter for AKI between Dec 2016-Mar 2020. People with catheters for AKI were slightly older, (median age 64.0 (Interquartile range (IQR) 51.2-72.9 years vs 62.0 (IQR 49.6-72.4 years)), 37% female, but had lower rates of diabetes (32% vs 52%; p=0.005) and tunnelled catheters (32% vs 52%; P<0.001) compared to those with catheters for other causes. Rates of HD-CRBSI in those with a catheter for AKI were 0.389 confirmed infections/1000 catheter days, versus 0.317 confirmed infections/1000 catheter days in those with a catheter for other causes, with no impact on the adjusted HD-CRBSI rates between the baseline and intervention phases (IRR 1.42 (95% CI 0.57 – 3.52; p=0.446) for those with a catheter for AKI.
Conclusions: These results suggest while the intervention bundle did not impact the rates of AKI, 30% of all dialysis catheters inserted in Australia are inserted for AKI. Future analyses will report on the duration and long-term outcomes of people with catheters for AKI.
Biography:
A/Prof Sradha Kotwal is the Program head of the Renal and Metabolic program at The George Institute and a staff specialist nephrologist at Prince of Wales Hospital. She led the REDUCCTION trial and was involved in all aspects of the trial.