Reducing the Burden of Dialysis Catheter Complications: A National Approach - Design and Baseline Results

Sradha Kotwal, Sarah Coggan, Stephen McDonald, Girish Talaulikar, Alan Cass, Stephen Jan, Kevan R Polkinghorne, Nicholas A. Gray, Martin Gallagher

Research output: Contribution to journalArticlepeer-review

Abstract

Background Patients with hemodialysis central venous catheters (HD CVCs) are susceptible to health careassociated infections, particularly hemodialysis catheter-related bloodstream infection (HD-CRBSI), which is associated with high mortality and health care costs. There have been few systematic attempts to reduce this
burden and clinical practice remains highly variable. This manuscript will summarize the challenges in preventing HD-CRBSI and describe the methodology of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.

Methods
The REDUCCTION trial is a stepped-wedge cluster randomized trial of a suite of clinical interventions aimed at reducing HD-CRBSI across Australia. It clusters the intervention at the renal-service level with implementation randomly timed across three tranches. The primary outcome is the effect of this intervention upon the rate of HD-CRBSI. Patients who receive an HD CVC at a participating renal service are eligible for inclusion. A customized data collection tool allows near-to-real-time reporting of the number of active catheters, total exposure to catheters over time, and rates of HD-CRBSI in each service. The interventions are centered
around the insertion, maintenance, and removal of HD CVC, informed by the most current evidence at the time of
design (mid-2018).

Results A total of 37 renal services are participating in the trial. Data collection is ongoing with results expected in the last quarter of 2020. The baseline phase of the study has collected provisional data on 5385 catheters in 3615 participants, representing 603,506 days of HD CVC exposure.

Conclusions The REDUCCTION trial systematically measures the use of HD CVCs at a national level in Australia, accurately determines the rate of HD-CRBSI, and tests the effect of a multifaceted, evidence-based intervention upon the rate of HD-CRBSI. These results will have global relevance in nephrology and other specialties commonly using CVCs
Original languageEnglish
Pages (from-to) 746–754
Number of pages34
JournalKidney360
Volume1
Issue number8
DOIs
Publication statusPublished - Aug 2020

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