Hemodialysis CRBSI Outcomes Unaffected by Distance to Nephrologists

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Canadian study reveals no significant effect of driving distance to a nephrology practice on the rate and appropriate management of catheter-related bloodstream infections.
Canadian study reveals no significant effect of driving distance to a nephrology practice on the rate and appropriate management of catheter-related bloodstream infections.

Hemodialysis (HD) patient driving distance to the closest nephrology practice does not influence the rate of catheter-related bloodstream infections (CRBSI) or its management, a new study suggests.

In a prospective study of 1131 patients initiating HD with a central venous catheter (CVC) in Alberta, Canada, investigators led by Marcello Tonelli, MD, of the University of Calgary, Alberta, found no significant difference in the rate ratio of CRBSI among 3 categories of driving distance to the nearest nephrology practice: less than 50 km (896 patients), 50–99 km (95 patients), and 100 km or more (140 patients). With patients living less than 50 km driving distance to the closest nephrology practice as the reference group, the 50–99 and 100 km or more groups had a CRBSI rate ratio of 1.63 and 0.84, respectively, Dr Tonelli and his colleagues reported in BMC Nephrology (2017;18:357).

In addition, the investigators found no significant difference in the rate ratio of bacteremia. Compared with the reference group, patients in the 50–99 and 100 km or more groups had a bacteremia rate ratio of 1.42 and 0.79, respectively.

The overall incidence of CRBSIs was low (0.19 per 1000 catheter days), according to the investigators.

Participants were followed up for a median of 755 days. Of 132 patients with at least 1 episode of CRBSI, there were 105 hospitalization in 103 patients. Of the 164 infections due to confirmed or suspected CRBSI, the CVC was removed in 135 cases, of which 120 were considered timely catheter removals. The investigators reported finding no evidence that these events were associated with distance from nephrologist practices.

“Contrary to our initial hypothesis, we did not find that remote location was associated with a lower odds of timely dialysis CVC removal or a higher frequency of relapsing bacteremia.”

According to the investigators, the low incidence of CRBSI in their cohort is a possible reason they found no difference in CRBSI rates and indicators of appropriate CRBSI management according to distance. Statistical power was too low to detect a difference between distance categories.

Reference

Thompson S, Wiebe N, Klarenbach S, et al. Catheter-related blood stream infection in hemodialysis patients: a prospective cohort study.  BMC Nephrol 2017;18:357.

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