Rates and Outcomes of Dialysis Events Among Hemodialysis Outpatients in Saudi Arabia; 18 months Multicenter Study

Background Monitoring dialysis events and outcomes are crucial for proper care of hemodialysis patients. Regular dialysis surveillance doesn’t focus on outcomes of dialysis events. The objective was to estimate clinical outcomes and associated risk factors among hemodialysis patients who had one or more dialysis events. Methods A retrospective chart-review study was conducted at four outpatients’ dialysis centers in Saudi Arabia. Data were collected from patients’ medical records. Dialysis events were documented according to the definitions of the US National Healthcare Safety Network (NHSN). Results During 15,859 patient months of surveillance, 541 patients developed one or more dialysis events. The mean age was 60.1 ± 16.4 and 55.3% were male. The overall rate of dialysis events was 3.41 per 100 patient-months. The corresponding rates were 3.05 for IV antimicrobial starts, 1.29 for positive blood cultures, and 0.68 for local site infections. Among patients who experienced one or more dialysis events, the most common adverse outcome was hospitalization (37.3%), followed by a loss of vascular access (27.3%) and mortality (2.2%). Patients with central venous catheter (CVC) had higher hospitalization (42.5% versus 16.0%, p < 0.001) and loss of vascular access (33.5% versus 1.0%, p < 0.001). In multivariate analysis, hospitalization/death was significantly associated with positive blood culture (OR, 12.63), heart failure (OR, 4.56), vascular access infection (OR, 2.80), and ischemic heart disease (OR, 1.98). Conclusions The current study provide benchmarking data for adverse outcomes for various dialysis events. The findings underscore the need to reduce catheter dependence, promote creation of arteriovenous fistula, and enhance catheter care protocols.