S KOTWAL1,2, G TALAULIKAR3, N GRAY4, K POLKINGHORNE5, S MCDONALD6, A CASS7, M GALLAGHER1,8
1Prince Of Wales Hospital, Sydney, Randwick, Australia, 2The George Institute for Global Health, Sydney, Australia, 3Renal Services, ACT Health, Canberra, Australia, 4Sunshine Coast University Hospital, Birtinya, Australia, 5Monash Medical Centre, Melbourne, Australia, 6ANZDATA Registry, Adelaide, Australia, 7Menzies School of Health Research, Darwin, Australia, 8Concord Clinical School, University of Sydney, Sydney, Australia
Aim: Understand the reasons for dialysis catheter insertion in patients of Australian renal units participating in a prospective national project (Reducing the burden of dialysis catheter complications – REDUCCTION).
Background: Dialysis catheters are inserted for reasons which are not well measured or understood. Understanding reasons for catheter insertion on a real-time basis allows units to measure practice and catheter use in a national context.
Methods: Data was collected using a web-based data collection tool on all patients who had a dialysis catheter inserted between 20/12/2016 and 23/03/2018 (censored) at any of the 37 units participating in the REDUCCTION project. The reasons for insertions were grouped into Acute Kidney Injury (AKI), commencement of maintenance dialysis, arteriovenous fistula/graft (AVF/AVG) dysfunction, transition from Peritoneal Dialysis (PD) without permanent vascular access and other as reported by study site.
Results: Data on 3572 (2522 patients) dialysis catheters were captured, representing 316,039 catheter days. Of these, 1176 (32.5%; 60% Tunnelled) catheters were inserted for AKI, 1047 (29.4%; 85.8% tunnelled) for commencement of maintenance dialysis, 464 (13%) for AVF/AVG dysfunction, 401 (11.3%) for transition from PD and 481 catheters (13.5%) for other reasons. Twenty-nine catheters were inserted in 27 patients for failing renal transplants. A total of 1075 catheters remained in situ at the censor date while 2497 catheters were removed after a median of 18 days (IQR 6-71 days). The median duration for tunnelled catheters was 75 days (IQR 26-170) and non-tunnelled catheters was 6 (IQR 3-9) days.
Conclusion: The data suggest opportunities to reduce catheter usage by understanding patients with AKI requiring dialysis better, identifying those starting chronic HD in a timely fashion and better managing the transition from PD.
Dr Kotwal is a nephrologist at Prince of Wales Hospital in Sydney Australia and a post-doctoral research fellow at the George Institute of Global Health. Her main area of interests lie in the use of linked health data and evidence implementation research.She has a background in epidemiology, biostatistics and the analysis of linked health data. She has designed and led multiple data linkage projects across Australia and has experience in analysis of large observational registry and administrative datasets.