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Published VersionCC BY-NC-ND V4.0, Open Access
Journal article
Effect of a multifaceted intervention on the incidence of haemodialysis catheter dysfunction in a national stepped-wedge cluster randomized trial
Kidney International Reports, Vol.8(10), pp.1941-1950
2023
Abstract
Introduction:
Effective strategies to prevent haemodialysis catheter dysfunction are lacking and there is wide variation in practice.
Methods:
In this post-hoc analysis of the REDUCCTION stepped-wedge cluster randomized trial, encompassing 37 Australian nephrology services, 6361 participants and 9872 catheters, we investigated whether the trial intervention, which promoted a suite of evidence-based practices for haemodialysis catheter insertion and management, reduced the incidence of catheter dysfunction, defined by catheter removal due to inadequate dialysis blood flow. We also analysed outcomes among tunnelled cuffed catheters and sources of event variability.
Results:
873 haemodialysis catheters were removed due to dysfunction over 1.12 million catheter days. The raw incidence was 0.91 events per 1000 catheter days during the baseline phase and 0.68 events per 1000 catheter days during the intervention phase. The service-wide incidence of catheter dysfunction was 33% lower during the intervention after adjustment for calendar time (Incidence-Rate Ratio (IRR) = 0.67, 95% confidence interval = 0.50 – 0.89, p=0.006). Results were consistent among tunnelled cuffed catheters (adjusted IRR = 0.68, 95% CI 0.49 – 0.94), which accounted for 75% of catheters (n = 7403), 97.4% of catheter exposure time and 88.2% of events (n = 770). Among tunnelled catheters that survived for 6 months (21.5% of tunnelled catheters), between 2-5% of the unexplained variation in the number of catheter dysfunction events was attributable to service-level differences, and 18-36% was attributable to patient-level differences.
Conclusion:
Multifaceted interventions that promote evidence-based catheter care may prevent dysfunction, and patient factors are an important source of variation in events.
Details
- Title
- Effect of a multifaceted intervention on the incidence of haemodialysis catheter dysfunction in a national stepped-wedge cluster randomized trial
- Authors
- Benjamin Lazarus (Corresponding Author) - The George Institute for Global HealthSradha Kotwal (Author) - The George Institute for Global HealthMartin Gallagher (Author) - The George Institute for Global HealthNicholas Gray (Author) - University of the Sunshine Coast, Queensland, School of Health and Behavioural Sciences - LegacySarah Coggan (Author) - The George Institute for Global HealthKris Rogers (Author) - The George Institute for Global HealthGirish Talaulikar (Author) - Australian National UniversityKevan R Polkinghorne (Author) - Monash UniversityREDUCCTION investigators (Author)
- Publication details
- Kidney International Reports, Vol.8(10), pp.1941-1950
- Publisher
- Elsevier Inc.
- Date published
- 2023
- DOI
- 10.1016/j.ekir.2023.07.013
- ISSN
- 2468-0249
- Copyright note
- This article is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
- Data Availability
- The individual patient data generated in the trial can be shared in accordance with the trial’s data sharing policy and in accordance with the local regulatory and ethical approval for the trial. The study protocol and statistical analysis plan have been published.
- Grants
- Grant note
- MRFF Next Generation TRIP Fellowship (MRF1150335)
- Organisation Unit
- UniSC Clinical Trials Centre; School of Health and Behavioural Sciences - Legacy
- Language
- English
- Record Identifier
- 99741895202621
- Output Type
- Journal article
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