Abstract: SA-PO920
Single Centre Experience of Vascular Access Related Infection Rates in Frequent HD
Session Information
- Dialysis: Home Hemodialysis
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 702 Dialysis: Home Hemodialysis
Authors
- Borman, Natalie L., Wessex Kidney Centre, Portsmouth, United Kingdom
- Gangaram, Venkat, Wessex Kidney Centre, Portsmouth, United Kingdom
- Sangala, Nicholas, Wessex Kidney Centre, Portsmouth, United Kingdom
Background
There are many benefits to Frequent Home HD (FHHD) but it only accounts for 0.4% of the dialysis population worldwide. One of the perceived barriers to FHHD relates to vascular acces srelated infections (VARI), as Infection is still the leading cause of morbidity and mortality in the dialysis population. Fear exists that frequent cannulation or use of vascular catheters (CVC) at home will increase this. Wessex Kidney Centre (WKC), Portsmouth, UK has a large HHD programme using NxStage. This retrospective study will review VARI and the strategies put in place to minimise them.
Methods
Data was collected on HHD patients between 2009- 2017. Demographic data, type of vascular access, proven bacteraemia via blood cultures and exit/cannulation site infections was collected. Rates of staph aureus bacteraemia were compared to UK Renal Association (UKRA) standards for HD. Monitoring methods in place were reviewed.
Results
Table 1 shows demographic data and number of VARI during this period. All patients received dialysis 5 or 6 times per week (20 patients received alternate night therapy).
Figure 1 shows staph aureus related bacteraemia per 100 patient months compared to UKRA standard.
The rate of all VARI were highest in the first 5 years and have since reduced despite increasing numbers on HHD. They are comparable to the UKRA standard.
Monitoring strategies and educational material have been put in place, including a real time monitoring app alerting the HHD team to any concerns, aiming to treat any infections early.
Conclusion
In this large FFHD cohort an increase in VARI rates were not observed despite frequent cannulation or use of CVC at home. Careful monitoring and ongoing education is essential to reduce infection rates and ensure prompt treatment.
Table 1
| Year | No of patients | Age | Sex | AVF / PTFE / CVC usage | Bactereamia | Exit/cannulation site infections |
| 2009-15 | 89 | 50 (18-80) | 60% Male | 69 / 7 / 13 | 11 | 7 |
| 2015-16 | 94 | 53 (19-82) | 65% Male | 66 / 15 / 26 | 3 | 1 |
| 2016-17 | 107 | 53 (19-83) | 66% Male | 70 / 8 / 29 | 5 | 5 |