Kidney Week

Abstract: TH-PO0961

Vascular Access-Specific Patterns of Intravenous Antibiotic Use Among Patients on Hemodialysis in ApolloDialDb

Session Information

• Vascular Access: Research and Cases
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 803 Dialysis: Vascular Access

Authors

• Winter, Anke, Renal Research Institute LLC, New York, New York, United States

Anke Winter, MD

• Meigel, Felix J., Renal Research Institute LLC, New York, New York, United States

Felix J. Meigel, PhD

• Wolf, Melanie, Renal Research Institute LLC, New York, New York, United States

Melanie Wolf, MS, MSc

• Guinsburg, Adrian M., Fresenius Medical Care, Madrid, Spain

Adrian M. Guinsburg, MD

• Chatoth, Dinesh K., Fresenius Medical Care, Global Medical Office, Fresenius Kidney Care, Waltham, Massachusetts, United States

Dinesh K. Chatoth, MD, FASN

• Usvyat, Len A., Renal Research Institute LLC, New York, New York, United States

Len A. Usvyat, PhD, FASN

• Fuertinger, Doris H., Renal Research Institute LLC, New York, New York, United States

Doris H. Fuertinger, PhD

Background

Vascular access type is a key determinant of infection risk in hemodialysis (HD) patients. We examined how intravenous antibiotic use varies by access type across three international regions.

Methods

We analyzed adult HD patients in the ApolloDialDb database ( 28 countries, January 2018–March 2021) from North America (NA), Europe, Middle East and Africa (EMEA), and Latin America (LA). Intravenous antibiotic administrations from a predefined panel (Cimino et al., Drugs 2021) were identified and categorized by predominant activity (Gram-positive, Gram-negative, or both). Vascular access was classified at the treatment level, prioritizing catheter when multiple types were recorded. Patient-time was computed as follow-up time on each access type, converted to patient-months. Antibiotic use was expressed as administrations per 100 patient-months and stratified by access type and region.

Results

The study included 479,137 patients contributing 7.21M patient-months (mean 15.8 vs 6.4 months/patient for fistula/graft vs catheter). Antibiotic administration rates were substantially higher with catheter versus fistula/graft (37.6 vs 9.4 per 100 patient-months). Antibiotic selection varied by both region and access type. In NA, catheter use was associated with greater Gram-negative coverage compared to fistula/graft (36.1% vs 19.1%), driven by a higher gentamicin utilization (26.6% vs 7.1%). In EMEA, catheter use was characterized by increased vancomycin utilization (42.0% vs 25.3%). In LA, the proportion of Gram-positive antibiotics were similar across access types (76.7% vs 75.6%).

Conclusion

Intravenous antibiotic use varied substantially by vascular access type, with higher utilization among patients with catheter access. We observed heterogeneity in antibiotic selection and spectrum of coverage by region. Further investigations are warranted to elucidate the underlying possible causes for these differences.

Funding

• Commercial Support – Fresenius Medical Care