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Abstract: TH-PO275

Concordance Between Site Reporting and Clinical Adjudication of Catheter-Related Infectious Events in Australian and New Zealand Kidney Services

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Catiwa, Jayson, The George Institute for Global Health, Newtown, New South Wales, Australia
  • Coggan, Sarah E., The George Institute for Global Health, Newtown, New South Wales, Australia
  • Cass, Alan, Charles Darwin University, Casuarina, Northern Territory, Australia
  • Gray, Nicholas A., Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
  • Jan, Stephen, The George Institute for Global Health, Newtown, New South Wales, Australia
  • McDonald, Stephen P., Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • Polkinghorne, Kevan, Monash University, Clayton, Victoria, Australia
  • Talaulikar, Girish S., ACT Health, Canberra City, Australian Capital Territory, Australia
  • 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

Group or Team Name

  • REDUCCTION Trial Investigators

Hemodialysis catheter-related bloodstream infection (HD CRBSI) are a significant source of morbidity and mortality among dialysis patients. Varying definitions and interpretations of HD CRBSI have made meaningful comparisons difficult. Attempts at systematically improving infection rates require a consistent approach in measuring HD CRBSI and understanding the feasibility and accuracy of this reporting is crucial.


We conducted an analysis of HD CRBSI events reported prospectively by all participating Australian and New Zealand (ANZ) kidney services between December 2016 to March 2020 within the REDUCCTION trial. Adult patients in a participating site who had a HD catheter inserted at any time after commencement of the trial or in whom the kidney service assumed the care of such catheter were included in the data collection. HD CRBSI events were assessed against the central adjudicators’ outcomes using the REDUCCTION trial's endpoint definition and adjudication process. We estimated the concordance between site-reported HD CRBSI and the corresponding adjudication outcomes using Cohen’s kappa statistic (κ) according to site clustering and implementation tranches in Australian sites as the New Zealand sites only participated in the observational phase.


The REDUCCTION trial has collected data on 7,258 patients and 12,630 catheters, representing 1.3 million catheter days across ANZ kidney services. A total of 779 HD catheter-related infectious events were reported by 42 ANZ sites within the 40-month trial period. The concordance from baseline to the last tranche of intervention implementation range from moderate to almost perfect. The overall concordance for HD CRBSI between sites and central adjudicators was κ=0.71 (95%CI 0.66-0.76).


Our study revealed a substantial level of concordance in HD CRBSI reporting between the participating kidney services and the REDUCCTION trial adjudicators, demonstrating reliability in Australian and New Zealand site-based reporting of HD CRBSI rates. While ascertaining HD CRBSI using a standardized definition allowed for comparable adjudication of outcomes with reliable benchmarking among ANZ kidney services, this remains unknown elsewhere in the world.


  • Government Support – Non-U.S.