Abstract: FR-PO550
Hemodialysis Catheter and Infections from a National US Cohort, 2018-2023
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Shieu, Monica, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
- Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
- Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
Background
Multiple factors have impacted arteriovenous hemodialysis (HD) vascular access creation and central venous catheter (CVC) usage throughout the pandemic. We describe longitudinal trends in CVC use, bloodstream infections (BSI), new IV antibiotics orders (ABX), and non-COVID-19 infection-related hospitalizations (INFH) from a national US dialysis provider.
Methods
Among adult maintenance HD patients treated at Dialysis Clinic, Inc. from 2018-2023, monthly percentages of patients with CVC, BSI, and ABX were calculated. INFH was defined by length of stay of at least 2 nights. For patients with a CVC, the mean time to first fistula/graft surgery was ascertained.
Results
Among 36,849 maintenance HD patients, there was a 44.4% increase in CVC use during the study period. There was a 40.7% decrease in INFH (Fig. 1a), 33.3% decrease in BSI, and 21.4% decrease in ABX (Fig. 1b). Among incident HD patients, CVC was the sole access present at initiation in 59% of patients in 2018, 62% in 2019, 67% in 2020, 69% in 2021, 72% in 2022, and 70% in 2023. Among initial access surgeries within the first year of a CVC, mean time to fistula/graft surgery was 97 days in 2018, 106 days in 2019, 107 days in 2020, 117 days in 2021, 121 days in 2022, and 124 days in 2023.
Conclusion
From 2018-2023, CVC use increased with more patients initiating HD with CVC alone and waiting longer for fistula/graft surgeries. Despite this, percentages of infections and ABX declined, suggesting maintenance of care process integrity within dialysis facilities, particularly infection precautions and prevention procedures during the pandemic. To minimize morbidity from CVC-related infections, the nephrology community should maintain these infection control practices and additionally work with regulators, payers, surgeons, and hospitals to reduce CVC use to pre-pandemic levels.