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Abstract: FR-OR56

Reducing the Burden of Dialysis Catheter Complications: A National Approach (REDUCCTION)

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Gallagher, Martin P., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Kotwal, Sradha S., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Talaulikar, Girish S., ACT Health, Canberra City, Australian Capital Territory, Australia
  • Gray, Nicholas A., Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
  • Polkinghorne, Kevan, Monash University, Clayton, Victoria, Australia
  • McDonald, Stephen P., Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia
  • Cass, Alan, Charles Darwin University, Casuarina, Northern Territory, Australia

Group or Team Name

  • on behalf of the REDUCCTION Investigators
Background

The major morbidity and cost from the use of central venous hemodialysis catheters is the increased risk of catheter-related blood stream infection (HD-CRBSI). Clinical practice remains variable and broad-scale, systematic interventions to reduce this burden have not been tested in randomized trials. The REDUCCTION trial aimed to systematically measure the rate of HD-CRBSI at a national level and test the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI in Australia.

Methods

This stepped wedge, randomized trial, clustered at the renal service level, included all patients receiving a central venous hemodialysis catheter in a participating renal service. After baseline data collection, services were randomly assigned to one of three time points (April 2018, Sept 2018, March 2019) for implementation of an intervention package based upon current evidence and guidelines. The primary outcome was the intervention’s effect upon the study wide service-level rate of HD-CRBSI (per 1000 catheter days).

Results

A total of 37 renal services in all Australian states and territories participated in the trial between Dec 2016 and March 2020. Preliminary analysis shows that 5246 catheters (3506 patients) were inserted during the baseline phase and 4610 catheters (3144 patients) in the intervention phase, representing more than 1.1 million catheter days of exposure and over 300 adjudicated HD-CRBSI events. Final analysis is currently in progress with results presented at the Annual Meeting.

Conclusion

The REDUCCTION trial has systematically measured the use of HD CVCs in near real-time and demonstrated the feasibility of implementing a suite of evidence-based interventions in haemodialysis care. The study outcomes will have implications for future research and practice in dialysis access.

Funding

  • Government Support - Non-U.S.