Abstract: SA-PO310
Establishing a Standardized Central Venous Catheter Rate
Session Information
- Hemodialysis and Frequent Dialysis: Potpourri
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Deluca, Thomas Pasquale, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Monaghan, Caitlin, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Belmonte, Kathleen, Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Larkin, John W., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Usvyat, Len A., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Hymes, Jeffrey L., Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts, United States
- Maddux, Franklin W., Fresenius Medical Care AG & Co KGaA, Bad Homburg, Hessen, Germany
Background
High central venous catheter (CVC) rates negatively affect dialysis patients around the world, with ailments such as CR-BSIs and thrombosis (Sohail, EKIR 2021). The process for getting a patient ready for AV access can be complex, thus catheter rates at clinics may be higher than expected. This model will be used as a tool to identify clinics that are performing worse than expected with CVC rates and aid to improve them.
Methods
The analysis was conducted on a sample of 143,411 active hemodialysis dialysis patients as of March 1st, 2022, with end stage kidney disease. Patients must have had a CVC for greater than 90 days to be included in the study. A stepwise logistic regression model was trained on the data, with outcome as CVC or not. The model used BMI, age, location (Rural or Urban), sex, vintage, comorbidities, and nursing home residence.
Results
Using a nationwide catheter prevalence threshold of 19% for classifying predictions as having a CVC or not, the model performance on a test dataset showed balanced accuracy=61% and area under the curve=0.68. Predicted probabilities for clinics of size greater than 25 patients, had similar predictions to the actual rates (Figure 1). The top 3 most important predictors are vintage, age, and BMI.
Conclusion
The standardized CVC rate model gives clinics a tool to identify patients that look like they may be a good candidate for AV access but currently have a CVC. This tool will allow direct intervention into the practices of clinics to reduce their catheter rates. The model is in early development and a pilot will be initiated to continue validation of the model.
Figure 1: Prediction of clinic’s catheter rates on the x axis vs their true catheter rates on the y axis. The oval highlights the clinics that are targeted for intervention.
Funding
- Commercial Support – Fresenius Medical Care