Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study

Hussein, Wael F.; Mohammed, Husham Qassim; Browne, Leonard D.; Plant, William D.; Stack, Austin G.

doi:10.1186/s12882-018-0873-x

Cited by 18 publications

(18 citation statements)

References 28 publications

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“…National and international guidelines along with national policy initiatives [6–9] recommend the use of arteriovenous fistula (AVF) whenever possible, as the risk of infections and other complications is highest among patients using central venous catheters (CVCs) [3, 10, 11]. Despite the dangers associated with CVC use, these devices remain the principal type of access in the majority of HD patients in Ireland [12, 13] and internationally [14].…”

Section: Introductionmentioning

confidence: 99%

Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study

et al. 2019

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Background Infections are the second leading cause of death and hospitalisation among haemodialysis (HD) patients. Rates of access-related bloodstream infections (AR-BSI) are influenced by patient characteristics and local protocols. We explored factors associated with AR-BSI in a contemporary cohort of HD patients at a tertiary nephrology centre. Methods A retrospective cohort of 235 chronic HD patients was identified from a regional dialysis programme between Jan 2015 and Dec 2016. Data on demographics, primary renal disease, comorbid conditions and dialysis access type were obtained from the Kidney Disease Clinical Patient Management System (KDCPMS ). Data on blood cultures were captured from the microbiology laboratory. Poisson regression with robust variance estimates was used to compare infection rates and relative risk of AR-BSI according to the site and type of vascular access. Results The mean age was 65 (± 15) years, 77% were men, and the median follow up was 19 months (IQR: 10–24 months), accumulating 2030 catheter-months and 1831 fistula-months. Overall rates of AR-BSI were significantly higher for central venous catheter (CVC) compared to arteriovenous fistula (AVF), (2.22, 95% (CI): 1.62–2.97) versus 0.11 (0.01–0.39) per 100 patient-months respectively), with a rate ratio of 20.29 (4.92–83.66), p < 0.0001. This pattern persisted across age, gender and diabetes subgroups. Within the CVC subgroup, presence of a femoral CVC access was associated with significantly higher rates of AR-BSI (adjusted RR 4.93, 95% CI: 2.69–9.01). Older age (75+ versus < 75 years) was not associated with significant differences in rates of AR-BSI in the unadjusted or the adjusted analysis. Coagulase negative Staphylococcus (61%) and Staphylococcus aureus (23%) were the predominant culprits. AR-BSIs resulted in access loss and hospitalisation in 57 and 72% of events respectively, and two patients died with concurrent AR-BSI. Conclusions Rates of AR-BSI are substantially higher in CVC than AVF in contemporary HD despite advances in catheter design and anti-infective protocols. This pattern was consistent in all subgroups. The policy of AVF preference over CVC should continue to minimise patient morbidity while at the same time improving anti-infective strategies through better care protocols and infection surveillance. Electronic supplementary material The online version of this article (10.1186/s12882-019-1253-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study

et al. 2019

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“…3 Despite all efforts, CVC remains the predominant use of vascular access in Ireland. 11 In this study CVC usage reached up to 55.2%. The study results fall in the range of CVC usage in Gulf countries ranging from 29% in Oman to 56% in Kuwait, which is considered high according to the international guidelines.…”

Section: Resultsmentioning

confidence: 51%

Current State of Vascular Access in Patients on Hemodialysis in Bahrain

2021

J Bah Med Soc

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Background & Objective: Patients on hemodialysis (HD) require well-functioning vascular access for its initiation and successful transition to dialysis. Arteriovenous fistula is recognized internationally as the first choice of vascular access due to its long lifespan and low incidence of complications in comparison to other methods. Despite this, the rates remain poor. The aim of the study was to document the trend of vascular access currently observed in the hemodialysis centers.Methodology: This is cross-sectional study in Hemodialysis Centers in Ministry of Health, Kingdom of Bahrain. All patients undergoing regular hemodialysis in May 2020 were included in this study.Results: A total of 536 patients undergoing regular renal replacement therapy were recruited. Majority of the patients; 478 (89.2%) were on hemodialysis. Of them, 214 (44.8%) patients were on arteriovenous fistula/graft (AVF/ AVG), while the remaining 264 (55.2%) were on tunnel line. Causes of tunnel line hemodialysis were further evaluated. About 137(51.9%) patients were undergoing investigations. This was followed by patient refusal and unfit for surgery among thirty-five (13.3%) and 23 (8.7%) patients, respectively. The remaining patients were either awaiting surgery, or experienced complications post arteriovenous fistula/graft creation. Conclusion:In this study, a high use of tunnel line vascular access in HD was observed in comparison to AVF. A potential for higher utilization of AVF/AVG up to 60% was observed in this practice. Further studies and strategies to increase the usage of AVF is highly recommended to reach international standards and improve patient care.

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“…We utilised the Kidney Disease Clinical Patient Management System (KDCPMS) as the primary data source to examine vascular access use in the Irish health system (12). The KDCPMS is a kidney-specific national information system that tracks patients from latestage CKD across the transition to end-stage kidney disease (ESKD) in all dialysis centres in Ireland.…”

Section: Data Sourcementioning

confidence: 99%

“…However, despite these efforts, the prevalence of functioning AVF at dialysis initation remain low for many countries and suggests that the appropriate planning, patient engagement and education process prior to dialysis onset fall short of expectations (8)(9)(10)(11)(12). It remains unclear to what extent patient-level factors contribute to the high dependency on CVC.…”

Section: Introductionmentioning

confidence: 99%

Evolution of Vascular Access Use among Incident Patients during the First Year on Hemodialysis: A National Cohort Study

et al. 2021

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Background: Although the arteriovenous fistula (AVF) confers superior benefits over central venous catheters (CVC), utilisation rates remain low among prevalent haemodialysis (HD) patients. The goal of this study was to determine the evolution of vascular access type in the first year of dialysis and identify factors associated with conversion from CVC to a functioning AVF. Methods: We studied adult patients (n=610) who began HD between the 01/01/2015 and 31/12/2016 and were treated for at least 90 days using data from the National Kidney Disease Clinical Patient Management System in the Irish Health System. Prevalence of vascular access type was determined at day 90 and 360 following dialysis initiation and at 30-day intervals. Multivariable logistic regression explored factors association with CVC at day 90, and Cox regression evaluated predictors of conversion from CVC to AVF on day 360. Results: CVC use was present in 77% of incident patients at day 90 with significant variation across HD centres (from 63 % to 91%, P<0.001) that persisted following case-mix adjustment. From day 90 to day 360, AVF use increased modestly from 23% to 41%. Conversion from CVC to AVF increased over time but the likelihood was lower for older patients [adjusted hazard ratio (HR) 0.43, 95% CI 0.19-0.96 for age >77yrs vs referent], for patients with lower BMI [HR 0.95, (0.93- 0.98) per unit decrease in BMI], and varied significantly across HD centres [from HR 0.25, (0.08-0.74) to 2.09 (1.04-4.18)]. Conclusion: CVC are the predominant type of vascular access observed during the first year of dialysis with low conversion rates from CVC to AVF. Substantial centre variation exists in the Irish health system that is not explained by patient-related factors alone.

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Prevalence and correlates of central venous catheter use among haemodialysis patients in the Irish health system - a national study

Cited by 18 publications

References 28 publications

Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study

Determinants and outcomes of access-related blood-stream infections among Irish haemodialysis patients; a cohort study

Current State of Vascular Access in Patients on Hemodialysis in Bahrain

Evolution of Vascular Access Use among Incident Patients during the First Year on Hemodialysis: A National Cohort Study

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