Prophylactic Antibiotics Before Insertion of Tunneled Hemodialysis Catheters: A Nationwide Cohort Study.

Rationale & Objective: It is unknown whether administration of prophylactic systemic antibiotics immediately before tunneled catheter insertion can prevent early hemodialysis catheter-related bloodstream infections (HDCRBSI). We aimed to estimate the effect of systemic prophylactic antibiotics on early HDCRBSI.

Study Design: An observational secondary analysis using data from the nationwide REDUcing the burden of dialysis Catheter ComplicaTIOns: a National approach trial.

The epidemiology of haemodialysis catheter infections in Australia, 2016-20: a prospective cohort study.

Objectives: To investigate the epidemiology in Australia of catheter-related infections in a national cohort of adults with kidney failure with incident haemodialysis central venous catheters (CVCs).

Study Design: Cohort study nested within a cluster-randomised trial (REDUcing the burden of dialysis Catheter Complications, REDUCCTION); analysis of prospectively collected trial data, linked with Australian and New Zealand Dialysis and Transplant (ANZDATA) registry and state hospitalisations data.

Setting: Thirty-four health services in Australia (excluding Western Australia) that provide chronic haemodialysis and participated in the REDUCCTION trial.

Variability in Dialysis Access Over Time and Across Centres in Australia and New Zealand: Effect of Centre- and Patient-Related Factors on Dialysis Access Quality Indicators.

Aim: The Australian and New Zealand Society of Nephrology (ANZSN) established a quality indicator (QI) program to measure performance and reduce variation of nephrology care. This program relies on registry data from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA). ANZDATA also conducts surveys to ascertain more granular characteristics of participating nephrology units to better understand variation in practice.

Factors Influencing Meal Provision and Dietary Support Behaviour of Caregivers of People with Chronic Kidney Disease: A Cross-Sectional Study.

Background/objectives: Caregivers play an important role in supporting care recipients to navigate their health needs, including adherence to dietary recommendations, which are complex and multifaceted. This study aims to (i) describe the nutrition knowledge of caregivers of people with chronic kidney disease (CKD), and (ii) explore caregivers' perceptions of their role in providing healthy meals and nutrition support for care recipients.

Methods: A cross-sectional study design employed a multi-strategy research approach.

Replacement Strategies for Tunneled Hemodialysis Catheters with Complications: A Nationwide Cohort Study.

Key Points: Replacement strategies for hemodialysis catheters with mechanical failure differed widely between services, which suggests clinical equipoise. For mechanical hemodialysis catheter failure, exchange did not result in more dysfunction or infection than removal and separate replacement. In Australia, infected catheters were almost universally removed and then replaced through a separate tunnel tract.

Patient Perspectives of Center-Specific Reporting in Kidney Failure Care: An Australian Qualitative Study.

Introduction: Public reporting of quality of care indicators in healthcare is intended to inform consumer decision-making; however, people may be unaware that such information exists, or it may not capture their priorities. The aim of this study was to understand the views of people with kidney disease about public reporting of dialysis and transplant center outcomes.

Methods: This qualitative study involved 27 patients with lived experience of kidney disease in Australia who participated in 11 online focus groups between August and December 2022.

Clinical Adjudication of Hemodialysis Catheter-Related Bloodstream Infections: Findings from the REDUCCTION Trial.

Key Points: The inter-rater reliability of reporting hemodialysis catheter-related infectious events between site investigators and trial adjudicators in Australia and New Zealand was substantial. The high concordance level in reporting catheter infections improves confidence in using site-level bacteremia rates as a clinical metric for quality benchmarking and future pragmatic clinical trials. A rigorous adjudication protocol may not be needed if clearly defined criteria to ascertain catheter-associated bacteremia are used.

Tunneled Hemodialysis Catheter Tip Design and Risk of Catheter Dysfunction: An Australian Nationwide Cohort Study.

Rationale & Objective: Hemodialysis catheter dysfunction is an important problem for patients with kidney failure. The optimal design of the tunneled catheter tip is unknown. This study evaluated the association of catheter tip design with the duration of catheter function.

Effect of a Multifaceted Intervention on the Incidence of Hemodialysis Catheter Dysfunction in a National Stepped-Wedge Cluster Randomized Trial.

Introduction: Effective strategies to prevent hemodialysis (HD) catheter dysfunction are lacking and there is wide variation in practice.

Methods: In this analysis of the REDUcing the burden of dialysis Catheter ComplicaTIOns: a national (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 HD catheter insertion and management, reduced the incidence of catheter dysfunction, which is defined by catheter removal due to inadequate dialysis blood flow. We also analyzed outcomes among tunneled cuffed catheters and sources of event variability.

Treatment decision-making and care among older adults with kidney failure: protocol for a multicentre, prospective observational cohort study with nested substudies and linked qualitative research (the Elderly Advanced CKD Programme).

Introduction: Shared treatment decision-making and planning of care are fundamental in advanced chronic kidney disease (CKD) management. There are limited data on several key outcomes for the elderly population including survival, quality of life, symptom burden, changes in physical functioning and experienced burden of healthcare. Patients, caregivers and clinicians consequently face significant uncertainty when making life-impacting treatment decisions.

The lived experience of haemodialysis patients managed with transmission-based precautions for MDRO colonisation: A qualitative study.

Background: Patients undergoing haemodialysis colonised with multi-drug resistant organisms (MDROs) are commonly managed with transmission-based precautions (TBP) to prevent nosocomial transmission. TBP have been linked to mixed effects on patient psychological well-being and clinical care. This study was designed to report the lived experience of dialysis patients managed with TBP.

Experiences of Caregivers of Patients With Conservatively Managed Kidney Failure: A Mixed Methods Systematic Review.

Background: Older people with kidney failure often choose conservative kidney care. The experiences and quality of life (QOL) of caregivers who support them are incompletely characterized.

Objective: To determine the burden, QOL, and understand experiences of caregivers supporting patients managed conservatively.

Complementary and alternative medicine use in an Australian kidney transplant recipient population.

The prevalence of complementary and alternative medicine (CAM) use in kidney transplant recipients in Australia is unknown. Chronic transplant recipients completed a questionnaire, and participants who did not report CAM use also had medical chart audits. Among 127 participants, CAM use was reported by 26.

Multifaceted intervention to reduce haemodialysis catheter related bloodstream infections: REDUCCTION stepped wedge, cluster randomised trial.

Objective: To identify whether multifaceted interventions, or care bundles, reduce catheter related bloodstream infections (CRBSIs) from central venous catheters used for haemodialysis.

Design: Stepped wedge, cluster randomised design.

Setting: 37 renal services across Australia.

Survey study of trends in adult nephrology advanced training in Australia and New Zealand.

Background: There has been considerable growth in nephrology advanced trainee numbers in Australia and New Zealand, with uncertain effects on clinical experience, competence and employment outcomes.

Aims: To review the perceived adequacy and temporal trends of advanced training in nephrology in Australia and New Zealand by evaluating training experiences, personal views on important aspects of training and nephrology, career paths and early employment outcomes.

Methods: An online survey was distributed to members of the Australian and New Zealand Society of Nephrology through email in December 2020.

A Mediterranean lifestyle is associated with favourable cardiometabolic markers in people with non-dialysis dependent chronic kidney disease.

Adherence to a Mediterranean lifestyle may be a useful primary and secondary prevention strategy for chronic kidney disease (CKD). This cross-sectional study aimed to explore adherence to a Mediterranean lifestyle and its association with cardiometabolic markers and kidney function in 99 people aged 73⋅2 ± 10⋅5 years with non-dialysis dependant CKD (stages 3-5) at a single Australian centre. Adherence was assessed using an index, the Mediterranean Lifestyle (MEDLIFE) index.

Telemedicine for Outpatient Care of Kidney Transplant and CKD Patients.

Introduction: Telehealth videoconferencing (TVC) may improve access in rural areas, but reported uptake and outcomes among kidney transplant recipients (KTRs) and chronic kidney disease (CKD) patients are limited. This study aimed to assess the feasibility, sustainability, and clinical outcomes of TVC for this patient population.

Methods: A total of 64 participants were recruited in this single-center, prospective, 2-year longitudinal, case-control study.

Quality of Life in Caregivers of Patients Randomized to Standard- Versus Extended-Hours Hemodialysis.

Introduction: Caregivers are essential for the health, safety, and independence of many patients and incur financial and personal cost in this role, including increased burden and lower quality of life (QOL) compared to the general population. Extended-hours hemodialysis may be the preference of some patients, but little is known about its effects on caregivers.

Methods: Forty caregivers of participants of the ACTIVE Dialysis trial, who were randomized to 12 months extended (median 24 hours/wk) or standard (12 hours/wk) hemodialysis, were included.

Midkine and chronic kidney disease-associated multisystem organ dysfunctions.

Chronic kidney disease (CKD) is a progressive multisystem condition with yet undefined mechanistic drivers and multiple implicated soluble factors. If identified, these factors could be targeted for therapeutic intervention for a disease that currently lacks specific treatment. There is increasing preclinical evidence that the heparin/endothelial glycocalyx-binding molecule midkine (MK) has a pathological role in multiple CKD-related, organ-specific disease processes, including CKD progression, hypertension, vascular and cardiac disease, bone disease and CKD-related cancers.

No evidence of a legacy effect on survival following randomization to extended hours dialysis in the ACTIVE Dialysis trial.

Aim: Extended hours haemodialysis is associated with superior survival to standard hours. However, residual confounding limits the interpretation of this observation. We aimed to determine the effect of a period of extended hours dialysis on long-term survival among participants in the ACTIVE Dialysis trial.

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

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.

Predictors of Change in Left-Ventricular Structure and Function in a Trial of Extended Hours Hemodialysis.

Background: Myocardial pathology is common in patients undergoing hemodialysis. To explore the effects of differing aspects of dialysis treatment on its evolution, we examined the impact of change in markers of volume status, hemodynamics and solute clearance on left ventricular (LV) parameters in a randomized trial of extended hours dialysis.

Methods And Results: A Clinical Trial of IntensiVE (ACTIVE) Dialysis randomized 200 patients undergoing hemodialysis to extended dialysis hours (≥ 24 hours/week) or standard hours (12-18 hours/week) for 12 months.

Varying Association of Extended Hours Dialysis with Quality of Life.

Background And Objectives: Little is known about the effect of changes in dialysis hours on patient-reported outcome measures. We report the effect of doubling dialysis hours on a range of patient-reported outcome measures in a randomized trial, overall and separately for important subgroups.

Design, Setting, Participants, & Measurements: The A Clinical Trial of IntensiVE Dialysis trial randomized 200 participants to extended or standard weekly hours hemodialysis for 12 months.

Effect of extended hours dialysis on markers of chronic kidney disease-mineral and bone disorder in the ACTIVE Dialysis study.

Background: Chronic Kidney Disease - Mineral and Bone Disorder (CKD-MBD) is a significant cause of morbidity among haemodialysis patients and is associated with pathological changes in phosphate, calcium and parathyroid hormone (PTH). In the ACTIVE Dialysis study, extended hours dialysis reduced serum phosphate but did not cause important changes in PTH or serum calcium. This secondary analysis aimed to determine if changes in associated therapies may have influenced these findings and to identify differences between patient subgroups.