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Randomized Controlled Trial
. 2020 Jun 2;1(8):746-754.
doi: 10.34067/KID.0001132020. eCollection 2020 Aug 27.

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) - design and baseline results

Sradha Kotwal  1   2 , Sarah Coggan  1 , Stephen McDonald  3 , Girish Talaulikar  4   5 , Alan Cass  6 , Stephen Jan  1 , Kevan R Polkinghorne  7   8 , Nicholas A Gray  9   10 , Martin Gallagher  1   5
Affiliations
Randomized Controlled Trial

REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach (REDUCCTION) - design and baseline results

Sradha Kotwal et al. Kidney360. .

Abstract

Background: Patients with hemodialysis central venous catheters (HD CVCs) are susceptible to health care-associated 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.

Keywords: Australia; bacteremia; catheterization; central venous catheters; crossinfection; dialysis; dialysis catheter; evidence-based medicine; health care costs; longitudinal studies; renal dialysis; vascular access.

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Conflict of interest statement

N. Gray reports personal fees from Baxter Healthcare and nonfinancial support from Amgen Australia outside the submitted work. M. Gallagher reports grants from Australian National Health and Medical Research Council, nonfinancial support from Multiple partner hospitals, grants from Victorian Department of Health, and grants from Queensland Department of Health during the conduct of the study; the George Institute and its affiliated entities work with numerous health and pharmaceutical companies in the design, implementation, and analyses of clinical research and clinical trials. It is possible that some of these companies have products relevant to the clinical space covered in this analysis, but Dr. Gallagher is not aware of any possible conflicts arising from this work. All remaining authors have nothing to disclose.

Figures

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Graphical abstract
Figure 1.
Figure 1.
Trial timelines.
Figure 2.
Figure 2.
Interventions information sheet. REDUCCTION, REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach.
See this image and copyright information in PMC

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