Haemodialysis catheter utilisation and factors associated with catheter-related bloodstream infection in Aotearoa New Zealand: Report from the binational, prospective, cluster-randomised trial.

BACKGROUND

Approximately 80% of the incident haemodialysis (HD) population in Aotearoa New Zealand relies on HD catheters for vascular access; however, utilisation patterns and outcomes remain poorly characterised.

AIM: We described the incidence and outcomes of HD catheters in Aotearoa New Zealand from the prospective data collected as part of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) trial.

METHODS

We prospectively collected patient and catheter characteristics from adults (≥18 years) commencing acute or maintenance HD with an incident catheter between August 2018 and March 2020 across six Aotearoa New Zealand nephrology services. The primary outcome was adjudicated-confirmed HD catheter-related bloodstream infections (CRBSIs). Survival analysis using a Cox proportional hazards regression model was performed to determine independent risk factors for HD CRBSI.

RESULTS

Among 894 patients (59 years (IQR 48-68), 58% male, 32% Māori), 1337 HD catheters were inserted corresponding to 157 142 catheter days. The confirmed HD CRBSI rate was 0.42/1000 catheter days (66 events). In the multivariable Cox regression, advancing age (HR 0.87 (95% CI 0.80, 0.95), P = 0.001) and tunnelled catheter use (HR 0.31 (0.13, 0.73), P = 0.007) were independently associated with lower HD CRBSI risk, while catheters inserted in operating theatres (HR 2.72 (1.08, 6.83), P = 0.03) were associated with increased infection risk. Methicillin-sensitive Staphylococcus aureus (39%) was the predominant pathogen in confirmed HD CRBSI events.

CONCLUSION

This study represents the first prospective analysis of HD CRBSI rates in Aotearoa New Zealand nephrology services, revealing encouragingly low rates. Tunnelled catheters and advancing age demonstrated an independent protective factor against HD CRBSI, a finding that may be relevant when considering HD access in older patients.