Haemodialysis catheter utilisation and factors associated with catheter‐related bloodstream infection in Aotearoa New Zealand: Report from the binational, prospective, cluster‐randomised trial
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".