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Abstract: PO1046

Hospitalization Risk and Long-Term Complications Associated with Catheter-Related Bloodstream Infection Among Hemodialysis Patients

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Rajagopalan, Krithika, Anlitiks Inc, Dover, Massachusetts, United States
  • Massey, Kenneth, Cormedix, Berkeley Heights, Massachusetts, United States
  • Rajagopalan, Srinivasan, Anlitiks Inc, Dover, Massachusetts, United States
  • Imperiale-Hagerman, Stephen, Anlitiks Inc, Dover, Massachusetts, United States
  • Chew, Paul, Cormedix, Berkeley Heights, Massachusetts, United States
Background

Central venous catheters (CVC) are frequently required for vascular access in hemodialysis (HD) and are commonly associated with catheter-related bloodstream infections (CRBSIs). CRBSIs may have devastating consequences leading to increased hospitalizations, and long-term complications such as stroke, myocardial infarction (MI), heart failure (HF), and endocarditis, among others. This analysis explores the risk of CRBSI-associated hospitalizations and long-term complications among HD patients.

Methods

A 1:1 propensity score matched case-control analysis was conducted using merged data from United States Renal Data System (USRDS), CROWNWeb (dialysis organizations), and Medicare claims database (2013-2017). All CVC-dependent HD patients from 2014-2016 with a 1-year pre- and ≥ 1-year post-index period were included. CRBSI was defined as a composite measure of its ICD codes or sepsis/bacteremia diagnosis with hospitalization or without occurring pneumonia, gangrene, or urinary tract infections and hospitalization. An assigned index date (i.e., CVC insertion date + median days to CRBSI reported in CRBSI-case group) was used to identify non-CRBSI patients. CRBSI/non-CRBSI group differences were described using frequency, mean, median, chi-square, and t-tests. At 1-year post CRBSI, adjusted differences in hospitalizations and hospital days and time to long-term complications were modeled using generalized linear models cox proportional hazard models, respectively.

Results

CRBSIs result in higher 1-year incremental rates of: stroke (6.6%), MI (9.2%), HF (13.4%), PVD (13.6%), and endocarditis (9.4%). Mean number of hospitalizations and hospital days were 3.79 and 25.0 days for CRBSI, and 1.96 and 5.86 days for non-CRBSI patients, respectively. Mean hospitalizations and hospital days were significantly higher for CRBSI vs. non-CRBSI patients (p<0.05) at 1-year post-CRBSI. Hazard ratios for CRBSI patients were: stroke (1.64, 95% CI 1.53-1.75), MI (2.56, 95% CI 2.37-2.78), HF (2.01, 95% CI 1.88-2.14), and endocarditis (13.42, 95% CI 10.97-16.42).

Conclusion

Results show HD patients with CRBSIs incur a significant morbidity burden due to increased hospitalizations, hospital days, and long-term complications such as stroke, MI, HF, PVD, and endocarditis.

Funding

  • Commercial Support