Abstract: FR-PO545
Access-Related Infections in Icelandic Patients on Hemodialysis
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
- Birgisdóttir, Lára Björk, Haskoli Islands, Reykjavik, Iceland
- Indridason, Olafur S., Landspitali, Reykjavik, Capital, Iceland
- Palsson, Runolfur, Landspitali, Reykjavik, Iceland
- Jonasdottir, Asta D., Landspitali, Reykjavik, Iceland
Background
Hemodialysis (HD) requires a well-functioning access to the vascular system, preferably an arteriovenous (AV) fistula or graft. Many patients initiate maintenance HD using a central venous catheter (CVC) which is prone to complications, including bacteremia. The aim of the study was to examine the frequency of CVC use for HD access in Iceland, and the incidence of catheter-related complications.
Methods
This was a retrospective study that included all patients aged >18 years who started HD for end-stage kidney disease in Iceland in 2017-2022. Demographic and clinical information, including the type of vascular access and access related complications was obtained from electronic medical records. Access-related bacteremia was defined as positive blood culture from a peripheral vein or the dialysis circuit and absence of other cause of the infection. The incidence of infections was calculated per patient-year for each access type.
Results
Among 164 patients who initiated HD during the study period, 79 (42.8%) started with a tunneled CVC as vascular access, 35 (21.3%) a non-tunneled CVC, 47 (28.7%) an AV fistula and 3 (1.8%) with an AV graft. A tunneled or non-tunneled CVC was used by 127 (77.4%) patients at some point. The use of tunneled CVCs increased during the study period, with 23 catheters placed in 18 individuals in 2017, while 38 were placed in 32 individuals in 2022. The use of non-tunneled CVCs decreased markedly, as13 such catheters were placed in 12 individuals in 2017, but only a single non-tunneled CVC in 2022. Cumulative patient-years with each access type was 98.2 for tunneled CVCs, 2.9 for non-tunneled CVCs, 198 for AV fistulas and 20.1 for AV grafts. The incidence of access-related bacteremia was 0.28 per patient-year (0.77 per 1000 CVC days) for tunneled CVCs, 1.37 per patient-year (3.8 per 1000 CVC days) for non-tunneled CVCs, 0.025 per patient-year for AV fistula, no bacteremia was observed in patients with AV grafts. The most common infectious agent was Staphylococcus aureus, causing 14 (37.8%) bacteremia episodes, followed by coagulase-negative staphylococci causing 10 (27%) episodes.
Conclusion
The use of CVCs is high in Iceland compared to other countries in Europe. However, the decreasing proportion of non-tunneled catheters is exemplary and likely explains the low incidence of bacteremia in patients with CVCs.