SAT-047 REASONS FOR DIALYSIS CATHETER INSERTION - REAL TIME DATA FROM THE REDUCCTION PROJECT.

Abstract

Introduction: More than half the patients starting chronic haemodialysis in Australia start with a dialysis access catheter, while rates of catheter use in renal units for acute kidney injury (AKI) are unknown. Catheter insertion rates have not been measured, and the reasons for their use explored on a systematic basis. Collecting data regarding catheter insertion, including reasons for use, on a real-time basis allows units to measure practice and place catheter use in a national context and ultimately will inform measures to reduce catheter utilisation. The aim of this abstract is to understand the reasons for dialysis catheter insertion in patients of Australian and New Zealand renal units participating in a prospective national project (Reducing the burden of dialysis catheter complications - REDUCCTION). Method(s): Data was collected using a web-based data collection tool on all patients who had a dialysis catheter inserted between 20/12/2016 and 06/11/2018 (censored) at any of the 42 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. Result(s): Data on 5806 (3962 patients) dialysis catheters were captured, representing 593,996 catheter days. Of these, 1975 (34%; 59% Tunnelled) catheters were inserted for AKI, 1802 (31%; 85% tunnelled) for commencement of maintenance dialysis, 774 (13%) for AVF/AVG dysfunction, 662 (11%) for transition from PD and 590 catheters (10%) for other reasons. The majority of catheters inserted were tunnelled (n=4355) and they contributed the most to the catheter day count (575,259 catheter days). A total of 1409 catheters remained in situ at the censor date while 4420 catheters were removed after a median of 23 days (IQR 7-99 days). The median duration for tunnelled catheters was 82 days (IQR 27-190) and non-tunnelled catheters was 6 (IQR 3-9) days. Conclusion(s): The data allows greater understanding of catheter usage across ANZ. by identifying those starting chronic HD in a timely fashion, best-practice approaches to preservation of AVF/AVG function and better managing the transition from PD. Prevention, early identification and better management of AKI to prevent progression to the requirement for dialysis may also reduce catheter use. The systematic measurement of outcomes will also allow definition of practices that are associated with both favourable and unfavourable clinical outcomes.Copyright © 2019