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

Rates and Outcomes of Dialysis Events Among Hemodialysis Outpatients in Saudi Arabia; 18 months Multicenter Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Rates and Outcomes of Dialysis Events Among Hemodialysis Outpatients in Saudi Arabia; 18 months Multicenter Study Raghad Al-Ajlan, Tahani Al-Dawsari, Aiman El-saed, Sarah Al-Fayez, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8356012/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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. Hemodialysis vascular access infection hospitalization complications Figures Figure 1 Background Chronic kidney disease is currently the seventh most common cause of death from noncommunicable disease worldwide [1]. The increasing burden of end-stage renal disease (ESRD) and its associated health challenges pose a significant global public health concern [2]. Although the incidence of ESRD has been stabilized in Western countries, the global prevalence of treated ESRD has considerably increased [2]. This increase is adding a pressure to hemodialysis care, as more than 80% of newly diagnosed ESRD patients are started on hemodialysis [3]. Saudi Arabia has seen a notable rise in the prevalence and occurrence of ESRD, surpassing many other nations [4]. This increase can be attributed to rapid lifestyle changes, significant population growth, increased life expectancy, and extensive urban development over the past three decades [4]. The utilization of hemodialysis in Saudi Arabia is growing by an average 5% annually [5]. The 2021 statistics showed that more than 20 thousand patients are receiving hemodialysis in 275 centers across Saudi Arabia [6]. Hemodialysis patients at higher risk of getting infection, due to factors such as impaired immunity from renal failure and the use of vascular access devices [7, 8]. They are also at higher risk of getting serious outcomes, including mortality, frequent hospitalization, infection, and vascular access problems [9, 10]. Around 20% of hemodialysis patients die within a year after starting dialysis, mainly due to cardiovascular problems [9, 11]. Hospitalization is frequent and related mainly to cardiovascular and infection events [12]. Monitoring infections in dialysis patients is a key element of prevention efforts [13]. Surveillance programs incorporating feedback for healthcare professionals about the rate of infection have been shown to effectively reduce HAIs and improve patient outcomes [14]. In the United States, the National Healthcare Safety Network (NHSN) established a dialysis event surveillance system to monitor dialysis events including antimicrobial starts, positive blood cultures, and signs of local infection [8]. Unfortunately, NHSN surveillance do not focus on outcomes of infection, such as mortality, hospitalization, and vascular access problems [15]. This data is also lacking in surveillance reports in Saudi Arabia [16-18]. Therefore, the objective of this study was estimate clinical outcomes including as vascular access loss, hospitalizations, and deaths among hemodialysis patients who had one or more dialysis events. Additionally, to identify outcome-associated risk factors. Methods Study design: This is an observational retrospective chart-review study design conducted at a blinded project and approved by the Institutional Review Board (IRB) at a blinded institution . The study collected data covering 18 months (from January 2023 to June 2024). Since the study was chart-review and the data were collected during routine care without direct interaction with patients, interfering with care received, or collection of sensitive information, informed consent from patients has been waived by the IRB, in accordance with institutional policy. Setting: The study was conducted at the outpatient centers of a blinded Project in three major cities. They included two centers in Riyadh, one center in Jeddah, and one center in Al Madinah. All included centers were affiliated with a blinded institution , which is a large healthcare system covering over two million individuals across Saudi Arabia. Population: This study targeted patients receiving maintenance hemodialysis at the outpatient centers of a blinded Project in three major cities. The study included adult patients aged 18 years or more who had experienced at least one dialysis event during the study period, regardless of outcome, including hospitalization and mortality. Transient patients who were temporary receiving hemodialysis in the studied centers were included in the study, if they underwent hemodialysis during the first two working days of an included month. Patients were excluded if they were exclusively receiving inpatient hemodialysis or peritoneal dialysis. Data collection: The required data were extracted from an electronic medical record (EMR) system called BESTCare. A structured data collection sheet was used to abstract the data from the BESTCare. This included three sections; demographic and clinical characteristics of patients, details of dialysis events experienced, and outcomes. Demographic and clinical data included age, gender, body mass index, comorbidity, dialysis duration, and vascular access type. Dialysis events included one or more of three dialysis events; intravenous (IV) antimicrobial start, positive blood culture, and the presence of pus, redness, or increased swelling at the vascular access site. Additionally, access-associated bacteremia and vascular access infections were created from the above information. Outcomes included post-event loss of vascular access (within 2 weeks), hospital admissions (within 2 weeks), and mortality (within 30 days). Dialysis event definitions: They were following the definitions set by the National Healthcare Safety Network (NHSN) [8]. More than one events were considered as long as the 21-day rule was implemented. The 21-day rule stipulated that if a second event occurred within 21 days for a similar event, only the first one is reported. A subsequent event was only considered if 21 days had passed without recurrence [8]. Statistical Analysis: Data management were implemented to ensure completeness and verification of collected data. Categorical variables were presented as frequencies and percentages. While continuous variables were presented using means and standard deviations or median and interquartile range (IQR), as appropriate. Dialysis events rates were calculated by dividing total events by the number of patient months and multiplying the result by 100. Overall and type-specific dialysis events were stratified by vascular access type; arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC) which included both permanent and temporary central lines. The calculated rates were compared to dialysis event rates published by the US NHSN [15]. Combined outcome (hospitalization or death) was used to categorize the patients, as all died patients but one were hospitalized and death numbers cannot support separate analysis. Chi-squared or Fisher's exact tests were used for categorical data, while t-tests or Mann-Whitney tests were used for continuous data, as appropriate. Multivariate logistic regression analysis was conducted to identify potential predictors of hospitalization/death. The analysis was done using backward elimination of all significant variables included in univariate analysis. A p-value of less than 0.05 was considered statistically significant for all two-tailed tests. SPSS (Version 27.0. Armonk, NY: IBM Corp) was used for all statistical analyses. Results During the study period from January 2023 to June 2024, a total of 15,859 patient months of surveillance were monitored across all four centers of the study. As shown in Table 1, 541 patients developed one or more dialysis events. Among those patients, the most common hemodialysis access was through CVC, utilized by 435 (80.4%) patients. Meanwhile, 92 (17.0%) patients used an AVF, and only 14 (2.6%) patients used an AFG. The majority of dialysis events reported were IV antimicrobial starts, which were observed in 89.5% of the patients, followed by positive blood cultures in 37.7%, and finally local site infections in 20% of the patients. The corresponding rates per 100 patient-months were 3.05, 1.29, and 0.68, respectively. The overall dialysis event rate was 3.41 per 100 patient-months. The highest event rate per 100 patient-months was observed in patients with CVC (5.99), followed by patients with AVG (2.63), and lastly patients with AVF (1.14). Among dialysis patients who experienced dialysis events, 208 had one or more documented adverse outcomes associated with these events (Table 1). Approximately 202 patients required hospitalization, 147 experienced loss of vascular access, and 12 patients died. The median (IQR) length of stay during hospitalization was 7 (5-10) days while the days between dialysis events and death was 21 (12-81). These represented 70.7%, 27.3%, and 5.8% of all adverse outcomes, respectively. The incidence of adverse events among patients with dialysis events was highest in hospitalization (37.3%), followed by a loss of vascular access (27.3%) and mortality (2.2%, Figure 1). Compared to patients with non-CVC access, patients with 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). The rates of adverse events per 100 patient-months were 1.27 for hospitalization, 0.93 for loss of vascular access, and 0.08 for mortality. Table 2 shows the benchmarking of the rates of dialysis event against corresponding NHSN rates. This was done while stratifying by type of event and type of access. Generally, IV antimicrobial start, local access site infection, and vascular access were lower than NHSN, with standardized infection ratio of 0.64, 0.55, and 0.72, respectively. On the other hand, positive blood culture and access-related bloodstream infections were higher than the NHSN rate, with standardized infection ratio of 1.13 for both. The excess risk of positive blood culture and access-related bloodstream infections was observed mainly in patients with AVG and CVC but not AVF. The demographic and clinical characteristics of patients who experienced dialysis events are summarized in Table 3 in relation to the development of adverse events including hospitalization or death. The mean age was 60.1±16.4 and 55.3% were male. Approximately 76.5% of the patients were from dialysis centres in the Riyadh region. Nearly all patients had one or more comorbidities, with the most common were hypertension (88.2%), diabetes (63.6%), obesity (35.1%), and ischemic heart disease (21.6%). The median (IQR) duration of dialysis was 2.2 (1.2-5.0) years. The average incidence of adverse events (hospitalization or death) was 37.3%. Higher rates of adverse events were significantly associated with Jeddah center (51.7%, p=0.030), having three or more comorbidity (47.9%, p=0.040), cancer (61.9%, p=0.030), ischemic heart disease (48.7%, p=0.030), heart failure (66.7%, p=0.003), and having CVC as the vascular access (42.5%, p<0.001). Supplementary Table 1 shows the associations of dialysis events and other outcomes by adverse events including hospitalization or death. As expected, dialysis events with the exception of local access site infection were significantly associated with higher rates of hospitalization or death. Additionally, the diagnosis of positive blood culture or starting the antimicrobial early during hospitalization was significantly associated with higher rates of hospitalization or death. Loss of vascular access was associated with higher hospitalization (98% versus 14.8%, p<0.001) and mortality (3.4% versus 1.8%, p=0.256). Supplementary Table 2 describes the independent risk factors of developing adverse events including hospitalization or death after experiencing one or more dialysis events. In multivariate analysis adjusted for all variables associated with adverse events in univariate analysis, the following factors were identified as independent predictors of hospitalization/death: positive blood culture (OR, 12.63; 95% CI: 6.99-22.83), heart failure (OR, 4.56; 95% CI: 1.23-16.93), vascular access infection (OR, 2.80; 95% CI: 1.56-5.03), and ischemic heart disease (OR, 1.98; 95% CI: 1.08-3.62). Discussion The current study estimated key clinical, including loss of vascular access, hospitalization, and death, and identified associated risk factors among hemodialysis patients who experienced at least one dialysis event. Rates of dialysis events by event type: The study estimated the overall dialysis event rates per 100 patient-months were 3.05 for in-unit IV antimicrobial initiation, 1.29 for positive blood cultures, and 0.68 for local access site infections. Consistent with findings, previous studies conducted in Saudi Arabia [16-18] and outside Saudi Arabia [15, 19-21] showed that IV antimicrobial initiation had the highest event rate compared to other events. However, antimicrobial initiation in this study lower than NHSN rates. The relatively higher antimicrobial use in this study was not necessarily as a result of bacteremia, which represented only 10% of cases. Actually, the majority of antimicrobial initiation was associated with clear documented indication (48%) or was used on empiric basis (29%). These findings underscore the urgent need to curb unnecessary or inappropriate antimicrobial use and to implement antimicrobial stewardship programs in all hemodialysis centers. Strengthening oversight and standardizing prescribing practices are critical steps toward reducing preventable complications and resistance development [22]. Rates of dialysis events by vascular access: Previous studies have consistently demonstrated that the rate of dialysis events are much higher among patients with CVC [15-21]. This was replicated in this study in all types of dialysis events. Moreover, CVC-associated bacteremia but not local infection was higher than NHSN rates. These findings highlight the inherent higher risk of infection associated with catheter use. This further emphasize the need to prioritize AFV creation whenever possible, enhance catheter care protocols, and prevention strategies tailored to the specific risks of each access type [23-25]. Loss of vascular access: Approximately 27% of the patients with at least one dialysis event in this study lost their vascular access. Comparing such data is challenging given the limited relevant data globally. Nevertheless, a Turkish study estimated the post-event rate of loss of vascular access at 18% [10]. It has been reported that loss of vascular access in non-CVC accesses is higher in the first year than subsequent years and CVC access is associated with lower patency on the long run [24]. Loss of vascular access is a serious event that increase the patient mortality [26]. This was confirmed in our study by significantly higher hospitalization and non-significant higher mortality among patients who lost their access compared to their counterparts. Additionally, almost all patients with loss of vascular access in this study were on CVC and caused by line sepsis. These findings again underscore the importance of promoting AVF creation and enhancing access care protocols [23-25]. Hospitalization: Approximately 37% of the patients with at least one dialysis event in this study were hospitalized. This is comparable to those reported in a large meta-analysis (38%) [11] but higher than reported in NHSN hospitals (22%) [15]. On the other hand, when compared to surveillance reports, hospitalization per100 patient-months in this study (average 1.27) was much lower than previous studies (range 4.3 to 8.7) [17, 20, 27]. This can be explained by the fact that we are reporting hospitalization among only patients who got dialysis events (per study protocol) not all patients on hemodialysis as in surveillance reports (per surveillance protocol). As seen in similar studies [17, 20, 27], the hospitalization rates in this study were markedly higher among patients with permanent central lines (2.55), compared to those with AVF (0.24) and AVG (0.19). For example, the hospitalization rates in NHSN hospitals in 2006 were double with permanent catheter compared with AVF (15.7 versus 7.7 per 100 patients months) [27]. Interestingly, the prevalence of AVF in population served by the centers included in this study was 50%, which is way lower than NHSN hospitals (80%) [15] and even local numbers in Saudi Arabia (60%) [16, 17]. This again underscore the need to promote initiation of hemodialysis using AFV [24, 25]. Mortality: Approximately 2.2% of the patients in this study died. This was slightly higher than post-event mortality in NHSN hospitals (0.8%) [15]. This could be related to the higher prevalence of CVC and lower AVF is our patients. It should be noted that the current figure was much lower than the average 20% death rate reported in the first year of dialysis [9, 11]. This is because mortality in this study was restricted to the 30-day mortality after dialysis events. Although the cause of death could not be identified in half of the patients, sepsis was the predominant cause among the rest of patients (4/6). Predictors of hospitalization and/or mortality: Multivariable analysis revealed vascular access infection specially those associated with bacteremia as well as cardiovascular disease (heart failure and ischemic heart disease) were independent predictors of hospitalization/death. Consistent with our findings, several studies highlighted that cardiovascular disease and the use of CVC as vascular access are among the risk factors for hospitalization in patients receiving hemodialysis [9, 12]. Strengths and limitations: This study has several notable strengths. The study is bridging a clear gap in the data regarding the outcomes of dialysis events. Such data is lacking locally and very limited internationally. By including multiple centers across these key regions, the study provides a broader perspective and enhances the generalizability of the findings. Nevertheless, some limitations should be acknowledged. The cross-sectional design does not establish causal relationships. The patient selection criteria specific to these attending outpatient centers favored clinically stable individuals may limit the generalizability of certain outcomes, particularly hospitalization/death rate. The incomplete information about the exact cause of hospitalization/death and the indications of antimicrobial use represented a data limitation. However, these limitations are expected in cross-sectional studies and are unlikely to affect the main study findings. Conclusion The patients in the current study experienced a high rate of in-unit IV antimicrobial starts and bloodstream infections, particularly among patients with CVC access. Among the patients with at least one dialysis event, 27% lost their vascular access, 37% were hospitalized, and 2.2% died. Similar to dialysis events, outcomes including loss of vascular access and hospitalization/death were significantly higher among patients with CVC. Vascular access infection specially those associated with bacteremia as well as cardiovascular disease were independent predictors of hospitalization/death. The findings underscore the need to reduce catheter dependence, prioritize AFV creation, and enhance catheter care protocols. Future studies may need to assess long-term outcomes of dialysis events in a prospective design. Declarations Ethics approval: This study was conducted in accordance with the Declaration of Helsinki principles . The project received the approval of the Research Ethics Committee of King Abdullah International Medical Research Center (protocol reference number NRR24/026/9) . Consent for publication: All authors gave their consent for a manuscript to be submitted and published. Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request and after approval of the IRB. Competing interests: The authors declare no conflicts of interest. Funding: None. Authors' contributions: Raghad Al-Ajlan and Tahani Al-Dawsari: Idea, data collection, and writing. Aiman El-Saed: Idea, analysis, and writing. Sarah Al-Fayez: Analysis and writing. Alaa Al-Sayed , Ebtehaj Al-Ahmari , Rana Al-Johani , Noelle Francesca Bambilla : Data collection and critical review. Majid Al-Shamrani: Supervision and critical review . References Wong G, Bernier-Jean A, Rovin B, Ronco P: Time for action: recognizing chronic kidney disease as a major noncommunicable disease driver of premature mortality. Kidney International 2024, 105(6):1144-1146. Thurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R: Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol 2021, 52(2):98-107. United States Renal Data System: USRDS annual data report. 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Tables Table 1: Dialysis events and outcomes by vascular access in patients receiving dialysis in four dialysis centers over 18 months Arteriovenous fistula Arteriovenous graft CVC Total Number of events Overall dialysis events 92 14 435 541 In-unit IV antimicrobial start 92 14 378 484 In-unit IV vancomycin start 19 2 89 110 Positive blood culture 14 3 187 204 Local access site infection 6 0 102 108 Access-related bloodstream infection 3 2 162 167 Vascular access infection 8 2 240 250 Number of outcomes Loss of vascular access 1 0 146 147 Hospitalization 17 0 185 202 Death 4 1 7 12 Hospitalization/death 19 1 185 202 Number of follow up months Riyadh-North 2670 233 2357 5260 Riyadh-South 2091 212 2680 4983 Madinah 1207 16 686 1909 Jeddah 2094 71 1542 3707 All centers 8062 532 7265 15859 Rate per 100 patient-months *Rate by dialysis event Overall dialysis events 1.14 2.63 5.99 3.41 In-unit IV antimicrobial start 1.14 2.63 5.20 3.05 In-unit IV vancomycin start 0.24 0.38 1.23 0.69 Positive blood culture 0.17 0.56 2.57 1.29 Local access site infection 0.07 0.00 1.40 0.68 Access-related bloodstream infection 0.04 0.38 2.23 1.05 Vascular access infection 0.10 0.38 3.30 1.58 *Rate by outcome Loss of vascular access 0.01 0.00 2.01 0.93 Hospitalization 0.21 0.00 2.55 1.27 Death 0.05 0.19 0.10 0.08 Hospitalization/death 0.24 0.19 2.55 1.27 IV, intravenous; CVC, Central venous catheter Table 2: Benchmarking of dialysis events relative to the US National Healthcare Safety Network Rates of current study 95% CI of current study Rates of NHSN Percentile bench-marking Observed number of events Expected number of events Standardized infection ratio In-unit IV antimicrobial start AV Fistulas 1.14 0.91-1.37 2.07 50th-75th 92 167 0.55 AV Graft 2.63 1.25-4.01 2.63 50th-75th 14 14 1.00 CVC 5.20 4.68-5.73 7.91 50th-75th 378 575 0.66 Total 3.05 2.78-3.32 3.27 50th-75th 484 756 0.64 Positive blood culture AV Fistulas 0.17 0.08-0.26 0.26 50th-75th 14 21 0.67 AV Graft 0.56 0.00-1.20 0.39 50th-75th 3 2 1.45 CVC 2.57 2.21-2.94 2.16 50th-75th 187 157 1.19 Total 1.29 1.11-1.46 0.64 50th-75th 204 180 1.13 Local access site infection AV Fistulas 0.07 0.01-0.13 0.31 50th-75th 6 25 0.24 AV Graft 0.00 0.00-0.00 0.48 50th-75th 0 3 --- CVC 1.40 1.13-1.68 2.35 50th-75th 102 171 0.60 Total 0.68 0.55-0.81 0.72 50th-75th 108 198 0.55 Access-related bloodstream infection AV Fistulas 0.04 0.00-0.08 0.16 50th-75th 3 13 0.23 AV Graft 0.38 0.00-0.90 0.27 75th-90th 2 1 1.39 CVC 2.23 1.89-2.57 1.83 50th-75th 162 133 1.22 Total 1.05 0.89-1.21 0.49 50th-75th 167 147 1.13 Vascular access infection AV Fistulas 0.10 0.03-0.17 0.46 50th-75th 8 37 0.21 AV Graft 0.38 0.00-0.90 0.75 50th-75th 2 4 0.50 CVC 3.30 2.89-3.72 4.19 50th-75th 240 304 0.79 Total 1.58 1.38-1.77 1.21 50th-75th 250 345 0.72 CI, confidence interval; NHSN, National Healthcare Safety Network; AV, arteriovenous; IV, intravenous; CVC, Central venous catheter Table 3: Demographic and clinical characteristics of patients with dialysis events by hospitalization/death status Overall Hospitalization/death p-value No Yes Dialysis center Riyadh-North 252 (46.6%) 167 (66.3%) 85 (33.7%) 0.030 Riyadh-South 162 (29.9%) 102 (63.0%) 60 (37.0%) Madinah 40 (7.4%) 25 (62.5%) 15 (37.5%) Jeddah 87 (16.1%) 42 (48.3%) 45 (51.7%) Age (years) Mean±SD 60.1±16.4 60.0±17.6 60.1±14.4 0.955 70 147 (27.2%) 100 (68.0%) 47 (32.0%) Gender Male 299 (55.3%) 187 (62.5%) 112 (37.5%) 0.817 Female 242 (44.7%) 149 (61.6%) 93 (38.4%) Body mass index 27.2±7.2 26.9±7.4 27.8±6.8 0.132 Number of comorbidities Mean±SD 2.7±1.2 2.6±1.2 2.8±1.3 0.077 None 10 (1.8%) 7 (70.0%) 3 (30.0%) 0.040 1-3 414 (76.5%) 268 (64.7%) 146 (35.3%) >3 117 (21.6%) 61 (52.1%) 56 (47.9%) Comorbidity Obesity 189 (35.1%) 110 (58.2%) 79 (41.8%) 0.186 Diabetes 344 (63.6%) 219 (63.7%) 125 (36.3%) 0.324 Hypertension 477 (88.2%) 299 (62.7%) 178 (37.3%) 0.451 Asthma or COPD 41 (7.6%) 20 (48.8%) 21 (51.2%) 0.069 Cancer 21 (3.9%) 8 (38.1%) 13 (61.9%) 0.021 Ischemic heart disease 117 (21.6%) 60 (51.3%) 57 (48.7%) 0.006 Heart failure 24 (4.4%) 8 (33.3%) 16 (66.7%) 0.003 Dyslipidemia 59 (10.9%) 39 (66.1%) 20 (33.9%) 0.503 Hypothyroidism 30 (5.5%) 21 (70.0%) 9 (30.0%) 0.359 Other comorbidities 130 (24.0%) 81 (62.3%) 49 (37.7%) 0.957 Duration of dialysis Median (IQR) 2.2 (1.2-5.0) 2.2 (1.3-4.8) 2.2 (1.1-5.8) 0.554 ≤3 years 337 (63.0%) 217 (64.4%) 120 (35.6%) 0.181 >3 years 198 (37.0%) 116 (58.6%) 82 (41.4%) Vascular access type CVC 435 (80.4%) 250 (57.5%) 185 (42.5%) <0.001 AV fistula 92 (17.0%) 73 (79.3%) 19 (20.7%) AV graft 14 (2.6%) 13 (92.9%) 1 (7.1%) SD, standard deviation; IQR, interquartile range; COPD, chronic obstructive pulmonary disease; AV, arteriovenous; CVC, Central venous catheter Additional Declarations No competing interests reported. Supplementary Files SupplementaryTables.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 08 Feb, 2026 Reviewers agreed at journal 29 Jan, 2026 Reviewers invited by journal 20 Jan, 2026 Editor invited by journal 27 Dec, 2025 Editor assigned by journal 25 Dec, 2025 Submission checks completed at journal 25 Dec, 2025 First submitted to journal 14 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":26306,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eIncidence of dialysis outcomes in patients with one or more dialysis events in four dialysis centers over 18 months\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8356012/v1/6767cf3b9c025f426b6ba1b0.png"},{"id":100953081,"identity":"35ca1d7a-f1d2-4e24-b270-f998a62a434f","added_by":"auto","created_at":"2026-01-23 07:19:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1422174,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8356012/v1/6ad54842-f01c-4935-8fb6-141562fde79e.pdf"},{"id":100929200,"identity":"f2ff0d39-555a-4496-89d6-1447368c6b0f","added_by":"auto","created_at":"2026-01-23 00:34:11","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20088,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8356012/v1/55fd92d3482044ddd3bfd2cf.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Rates and Outcomes of Dialysis Events Among Hemodialysis Outpatients in Saudi Arabia; 18 months Multicenter Study","fulltext":[{"header":"Background","content":"\u003cp\u003eChronic kidney disease is currently the seventh most common cause of death from noncommunicable disease worldwide [1]. The increasing burden of end-stage renal disease (ESRD) and its associated health challenges pose a significant global public health concern [2]. Although the incidence of ESRD has been stabilized in Western countries, the global prevalence of treated ESRD has considerably increased [2]. This increase is adding a pressure to hemodialysis care, as more than 80% of newly diagnosed ESRD patients are started on hemodialysis [3]. Saudi Arabia has seen a notable rise in the prevalence and occurrence of ESRD, surpassing many other nations [4]. This increase can be attributed to rapid lifestyle changes, significant population growth, increased life expectancy, and extensive urban development over the past three decades [4]. The utilization of hemodialysis in Saudi Arabia is growing by an average 5% annually [5]. The 2021 statistics showed that more than 20 thousand patients are receiving hemodialysis in 275 centers across Saudi Arabia [6].\u003c/p\u003e\n\u003cp\u003eHemodialysis patients at higher risk of getting infection, due to factors such as impaired immunity from renal failure and the use of vascular access devices [7, 8]. They are also at higher risk of getting serious outcomes, including mortality, frequent hospitalization, infection, and vascular access problems [9, 10]. Around 20% of hemodialysis patients die within a year after starting dialysis, mainly due to cardiovascular problems [9, 11]. Hospitalization is frequent and related mainly to cardiovascular and infection events [12]. \u003c/p\u003e\n\u003cp\u003eMonitoring infections in dialysis patients is a key element of prevention efforts [13]. Surveillance programs incorporating feedback for healthcare professionals about the rate of infection have been shown to effectively reduce HAIs and improve patient outcomes [14]. In the United States, the National Healthcare Safety Network (NHSN) established a dialysis event surveillance system to monitor dialysis events including antimicrobial starts, positive blood cultures, and signs of local infection [8]. Unfortunately, NHSN surveillance do not focus on outcomes of infection, such as mortality, hospitalization, and vascular access problems [15]. This data is also lacking in surveillance reports in Saudi Arabia [16-18]. Therefore, the objective of this study was estimate clinical outcomes including as vascular access loss, hospitalizations, and deaths among hemodialysis patients who had one or more dialysis events. Additionally, to identify outcome-associated risk factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design:\u003c/strong\u003e This is an observational retrospective chart-review study design conducted at a \u003cstrong\u003eblinded\u003c/strong\u003e project and approved by the Institutional Review Board (IRB) at a \u003cstrong\u003eblinded institution\u003c/strong\u003e. The study collected data covering 18 months (from January 2023 to June 2024). Since the study was chart-review and the data were collected during routine care without direct interaction with patients, interfering with care received, or collection of sensitive information, informed consent from patients has been waived by the IRB, in accordance with institutional policy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting:\u003c/strong\u003e The study was conducted at the outpatient centers of a \u003cstrong\u003eblinded\u003c/strong\u003e Project in three major cities. They included two centers in Riyadh, one center in Jeddah, and one center in Al Madinah. All included centers were affiliated with a \u003cstrong\u003eblinded institution\u003c/strong\u003e, which is a large healthcare system covering over two million individuals across Saudi Arabia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation:\u003c/strong\u003e This study targeted patients receiving maintenance hemodialysis at the outpatient centers of a \u003cstrong\u003eblinded\u003c/strong\u003e Project in three major cities. The study included adult patients aged 18 years or more who had experienced at least one dialysis event during the study period, regardless of outcome, including hospitalization and mortality. Transient patients who were temporary receiving hemodialysis in the studied centers were included in the study, if they underwent hemodialysis during the first two working days of an included month. \u0026nbsp;Patients were excluded if they were exclusively receiving inpatient hemodialysis or peritoneal dialysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e The required data were extracted from an electronic medical record (EMR) system called BESTCare. A structured data collection sheet was used to abstract the data from the BESTCare. This included three sections; demographic and clinical characteristics of patients, details of dialysis events experienced, and outcomes. Demographic and clinical data included age, gender, body mass index, comorbidity, dialysis duration, and vascular access type. Dialysis events included one or more of three dialysis events; intravenous (IV) antimicrobial start, positive blood culture, and the presence of pus, redness, or increased swelling at the vascular access site. Additionally, access-associated bacteremia and vascular access infections were created from the above information. Outcomes included post-event loss of vascular access (within 2 weeks), hospital admissions (within 2 weeks), and mortality (within 30 days).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDialysis event definitions:\u003c/strong\u003e They were following the definitions set by the National Healthcare Safety Network (NHSN) [8]. More than one events were considered as long as the 21-day rule was implemented. The 21-day rule stipulated that if a second event occurred within 21 days for a similar event, only the first one is reported. A subsequent event was only considered if 21 days had passed without recurrence [8].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis:\u003c/strong\u003e Data management were implemented to ensure completeness and verification of collected data. Categorical variables were presented as frequencies and percentages. While continuous variables were presented using means and standard deviations or median and interquartile range (IQR), as appropriate. Dialysis events rates were calculated by dividing total events by the number of patient months and multiplying the result by 100. Overall and type-specific dialysis events were stratified by vascular access type; arteriovenous fistula (AVF), arteriovenous graft (AVG), and central venous catheter (CVC) which included both permanent and temporary central lines. The calculated rates were compared to dialysis event rates published by the US NHSN [15]. Combined outcome (hospitalization or death) was used to categorize the patients, as all died patients but one were hospitalized and death numbers cannot support separate analysis. Chi-squared or Fisher\u0026apos;s exact tests were used for categorical data, while t-tests or Mann-Whitney tests were used for continuous data, as appropriate. Multivariate logistic regression analysis was conducted to identify potential predictors of hospitalization/death. The analysis was done using backward elimination of all significant variables included in univariate analysis. A p-value of less than 0.05 was considered statistically significant for all two-tailed tests. SPSS (Version 27.0. Armonk, NY: IBM Corp) was used for all statistical analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period from January 2023 to June 2024, a total of 15,859 patient months of surveillance were monitored across all four centers of the study. As shown in Table 1, 541 patients developed one or more dialysis events. Among those patients, the most common hemodialysis access was through CVC, utilized by 435 (80.4%) patients. Meanwhile, 92 (17.0%) patients used an AVF, and only 14 (2.6%) patients used an AFG. The majority of dialysis events reported were IV antimicrobial starts, which were observed in 89.5% of the patients, followed by positive blood cultures in 37.7%, and finally local site infections in 20% of the patients. The corresponding rates per 100 patient-months were 3.05, 1.29, and 0.68, respectively. The overall dialysis event rate was 3.41 per 100 patient-months. The highest event rate per 100 patient-months was observed in patients with CVC (5.99), followed by patients with AVG (2.63), and lastly patients with AVF (1.14).\u003c/p\u003e\n\u003cp\u003eAmong dialysis patients who experienced dialysis events, 208 had one or more documented adverse outcomes associated with these events (Table 1). Approximately 202 patients required hospitalization, 147 experienced loss of vascular access, and 12 patients died. The median (IQR) length of stay during hospitalization was 7 (5-10) days while the days between dialysis events and death was 21 (12-81). These represented 70.7%, 27.3%, and 5.8% of all adverse outcomes, respectively. The incidence of adverse events among patients with dialysis events was highest in hospitalization (37.3%), followed by a loss of vascular access (27.3%) and mortality (2.2%, Figure 1). Compared to patients with non-CVC access, patients with CVC had higher hospitalization (42.5% versus 16.0%, p\u0026lt;0.001) and loss of vascular access (33.5% versus 1.0%, p\u0026lt;0.001). The rates of adverse events per 100 patient-months were 1.27 for hospitalization, 0.93 for loss of vascular access, and 0.08 for mortality. \u003c/p\u003e\n\u003cp\u003eTable 2 shows the benchmarking of the rates of dialysis event against corresponding NHSN rates. This was done while stratifying by type of event and type of access. Generally, IV antimicrobial start, local access site infection, and vascular access were lower than NHSN, with standardized infection ratio of 0.64, 0.55, and 0.72, respectively. On the other hand, positive blood culture and access-related bloodstream infections were higher than the NHSN rate, with standardized infection ratio of 1.13 for both. The excess risk of positive blood culture and access-related bloodstream infections was observed mainly in patients with AVG and CVC but not AVF.\u003c/p\u003e\n\u003cp\u003eThe demographic and clinical characteristics of patients who experienced dialysis events are summarized in Table 3 in relation to the development of adverse events including hospitalization or death. The mean age was 60.1\u0026plusmn;16.4 and 55.3% were male. Approximately 76.5% of the patients were from dialysis centres in the Riyadh region. Nearly all patients had one or more comorbidities, with the most common were hypertension (88.2%), diabetes (63.6%), obesity (35.1%), and ischemic heart disease (21.6%). The median (IQR) duration of dialysis was 2.2 (1.2-5.0) years. The average incidence of adverse events (hospitalization or death) was 37.3%. Higher rates of adverse events were significantly associated with Jeddah center (51.7%, p=0.030), having three or more comorbidity (47.9%, p=0.040), cancer (61.9%, p=0.030), ischemic heart disease (48.7%, p=0.030), heart failure (66.7%, p=0.003), and having CVC as the vascular access (42.5%, p\u0026lt;0.001). \u003c/p\u003e\n\u003cp\u003eSupplementary Table 1 shows the associations of dialysis events and other outcomes by adverse events including hospitalization or death. As expected, dialysis events with the exception of local access site infection were significantly associated with higher rates of hospitalization or death. Additionally, the diagnosis of positive blood culture or starting the antimicrobial early during hospitalization was significantly associated with higher rates of hospitalization or death. Loss of vascular access was associated with higher hospitalization (98% versus 14.8%, p\u0026lt;0.001) and mortality (3.4% versus 1.8%, p=0.256).\u003c/p\u003e\n\u003cp\u003eSupplementary Table 2 describes the independent risk factors of developing adverse events including hospitalization or death after experiencing one or more dialysis events. In multivariate analysis adjusted for all variables associated with adverse events in univariate analysis, the following factors were identified as independent predictors of hospitalization/death: positive blood culture (OR, 12.63; 95% CI: 6.99-22.83), heart failure (OR, 4.56; 95% CI: 1.23-16.93), vascular access infection (OR, 2.80; 95% CI: 1.56-5.03), and ischemic heart disease (OR, 1.98; 95% CI: 1.08-3.62).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study estimated key clinical, including loss of vascular access, hospitalization, and death, and identified associated risk factors among hemodialysis patients who experienced at least one dialysis event.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRates of dialysis events by event type:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study estimated the overall dialysis event rates per 100 patient-months were 3.05 for in-unit IV antimicrobial initiation, 1.29 for positive blood cultures, and 0.68 for local access site infections. Consistent with findings, previous studies conducted in Saudi Arabia [16-18] and outside Saudi Arabia [15, 19-21] showed that IV antimicrobial initiation had the highest event rate compared to other events. However, antimicrobial initiation in this study lower than NHSN rates. The relatively higher antimicrobial use in this study was not necessarily as a result of bacteremia, which represented only 10% of cases. \u0026nbsp;Actually, the majority of antimicrobial initiation was associated with clear documented indication (48%) or was used on empiric basis (29%). These findings underscore the urgent need to curb unnecessary or inappropriate antimicrobial use and to implement antimicrobial stewardship programs in all hemodialysis centers. Strengthening oversight and standardizing prescribing practices are critical steps toward reducing preventable complications and resistance development [22].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRates of dialysis events by vascular access:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrevious studies have consistently demonstrated that the rate of dialysis events are much higher among patients with CVC [15-21]. This was replicated in this study in all types of dialysis events. Moreover, CVC-associated bacteremia but not local infection was higher than NHSN rates. These findings highlight the inherent higher risk of infection associated with catheter use. This further emphasize the need to prioritize AFV creation whenever possible, enhance catheter care protocols, and prevention strategies tailored to the specific risks of each access type [23-25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLoss of vascular access:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 27% of the patients with at least one dialysis event in this study lost their vascular access. Comparing such data is challenging given the limited relevant data globally. Nevertheless, a Turkish study estimated the post-event rate of loss of vascular access at 18% [10]. It has been reported that loss of vascular access in non-CVC accesses is higher in the first year than subsequent years and CVC access is associated with lower patency on the long run [24]. Loss of vascular access is a serious event that increase the patient mortality [26]. This was confirmed in our study by significantly higher hospitalization and non-significant higher mortality among patients who lost their access compared to their counterparts. Additionally, almost all patients with loss of vascular access in this study were on CVC and caused by line sepsis. These findings again underscore the importance of promoting AVF creation and enhancing access care protocols [23-25].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHospitalization:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 37% of the patients with at least one dialysis event in this study were hospitalized. This is comparable to those reported in a large meta-analysis (38%) [11] but higher than reported in NHSN hospitals (22%) [15]. On the other hand, when compared to surveillance reports, hospitalization per100 patient-months in this study (average 1.27) was much lower than previous studies (range 4.3 to 8.7) [17, 20, 27]. \u0026nbsp;This can be explained by the fact that we are reporting hospitalization among only patients who got dialysis events (per study protocol) not all patients on hemodialysis as in surveillance reports (per surveillance protocol). As seen in similar studies [17, 20, 27], the hospitalization rates in this study were markedly higher among patients with permanent central lines (2.55), compared to those with AVF (0.24) and AVG (0.19). For example, the hospitalization rates in NHSN hospitals in 2006 were double with permanent catheter compared with AVF (15.7 versus 7.7 per 100 patients months) [27]. Interestingly, the prevalence of AVF in population served by the centers included in this study was 50%, which is way lower than NHSN hospitals (80%) [15] and even local numbers in Saudi Arabia (60%) [16, 17]. This again underscore the need to promote initiation of hemodialysis using AFV [24, 25].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMortality:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately 2.2% of the patients in this study died. This was slightly higher than post-event mortality in NHSN hospitals (0.8%) [15]. This could be related to the higher prevalence of CVC and lower AVF is our patients. It should be noted that the current figure was much lower than the average 20% death rate reported in the first year of dialysis [9, 11]. This is because mortality in this study was restricted to the 30-day mortality after dialysis events. Although the cause of death could not be identified in half of the patients, sepsis was the predominant cause among the rest of patients (4/6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of hospitalization and/or mortality:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMultivariable analysis revealed vascular access infection specially those associated with bacteremia as well as cardiovascular disease (heart failure and ischemic heart disease) were independent predictors of hospitalization/death. Consistent with our findings, several studies highlighted that cardiovascular disease and the use of CVC as vascular access are among the risk factors for hospitalization in patients receiving hemodialysis [9, 12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several notable strengths. The study is bridging a clear gap in the data regarding the outcomes of dialysis events. Such data is lacking locally and very limited internationally. By including multiple centers across these key regions, the study provides a broader perspective and enhances the generalizability of the findings. Nevertheless, some limitations should be acknowledged. The cross-sectional design does not establish causal relationships. The patient selection criteria specific to these attending outpatient centers favored clinically stable individuals may limit the generalizability of certain outcomes, particularly hospitalization/death rate. The incomplete information about the exact cause of hospitalization/death and the indications of antimicrobial use represented a data limitation. However, these limitations are expected in cross-sectional studies and are unlikely to affect the main study findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe patients in the current study experienced a high rate of in-unit IV antimicrobial starts and bloodstream infections, particularly among patients with CVC access. Among the patients with at least one dialysis event, 27% lost their vascular access, 37% were hospitalized, and 2.2% died. Similar to dialysis events, outcomes including loss of vascular access and hospitalization/death were significantly higher among patients with CVC. Vascular access infection specially those associated with bacteremia as well as cardiovascular disease were independent predictors of hospitalization/death. The findings underscore the need to reduce catheter dependence, prioritize AFV creation, and enhance catheter care protocols. Future studies may need to assess long-term outcomes of dialysis events in a prospective design.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e This study was conducted in accordance with the Declaration of Helsinki principles\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project received the approval of the Research Ethics Committee of King Abdullah International Medical Research Center (protocol reference number NRR24/026/9)\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eAll authors gave their consent for a manuscript to be submitted and published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eThe datasets used and analyzed during the current study are available from the corresponding author on reasonable request and after approval of the IRB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNone.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRaghad Al-Ajlan\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;Tahani Al-Dawsari:\u003c/strong\u003e Idea, data collection, and writing.\u0026nbsp;\u003cstrong\u003eAiman El-Saed:\u003c/strong\u003e Idea, analysis, and writing. \u003cstrong\u003eSarah Al-Fayez:\u0026nbsp;\u003c/strong\u003eAnalysis and writing.\u003cstrong\u003e\u0026nbsp;Alaa Al-Sayed\u003c/strong\u003e, \u003cstrong\u003eEbtehaj Al-Ahmari\u003c/strong\u003e, \u003cstrong\u003eRana Al-Johani\u003c/strong\u003e, \u003cstrong\u003eNoelle Francesca Bambilla\u003c/strong\u003e: Data collection and critical review. \u003cstrong\u003eMajid Al-Shamrani:\u0026nbsp;\u003c/strong\u003eSupervision and critical review\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWong G, Bernier-Jean A, Rovin B, Ronco P: Time for action: recognizing chronic kidney disease as a major noncommunicable disease driver of premature mortality. Kidney International 2024, 105(6):1144-1146.\u003c/li\u003e\n\u003cli\u003eThurlow JS, Joshi M, Yan G, Norris KC, Agodoa LY, Yuan CM, Nee R: Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy. Am J Nephrol 2021, 52(2):98-107.\u003c/li\u003e\n\u003cli\u003eUnited States Renal Data System: USRDS annual data report. URL: https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease/1-incidence-prevalence-patient-characteristics-and-treatment-modalities (Last accessed August 1, 2025). In.; 2024.\u003c/li\u003e\n\u003cli\u003eAlkhlaif AA, Alsuraimi AK, Bawazir AA: Epidemiological Profile of End-Stage Renal Diseases in Riyadh, Saudi Arabia. Asian Journal of Medicine and Health 2020, 18(7):16-27.\u003c/li\u003e\n\u003cli\u003eSaudi Center for Organ Transplantation annual reports: Annual Report for Organ Transplantation in Kingdom of Saudi Arabia. URL: https://www.scot.gov.sa/en/reports-and-statistics/annual-reports (Last accessed August 1, 2025). 2020.\u003c/li\u003e\n\u003cli\u003eAlghamdi LS, Alonazi W: The utilization of renal dialysis: a comprehensive study in Saudi Arabia. BMC Public Health 2024, 24(1):1914.\u003c/li\u003e\n\u003cli\u003eWu Y-L, Zhang J-j, Li R-J, Cai C, Zhang Y, Xu T, Jiang Y, Xu L, Yang L-q, Yang X-Y: Prevalence of infections and antimicrobial use among hemodialysis outpatients: A prospective multicenter study. Seminars in Dialysis 2020, 33:156 - 162.\u003c/li\u003e\n\u003cli\u003eNational Healthcare Safety Network: Dialysis Event Surveillance Manual. URL: https://www.cdc.gov/nhsn/pdfs/pscmanual/8pscdialysiseventcurrent.pdf (Last accessed 1 August, 2025). 2024.\u003c/li\u003e\n\u003cli\u003eBello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, Wainstein M, Johnson DW: Epidemiology of haemodialysis outcomes. Nat Rev Nephrol 2022, 18(6):378-395.\u003c/li\u003e\n\u003cli\u003eHasanoglu I, Guner R, Sahin S, Yılmaz Karadag F, Parmaksiz E, Atalay HV, Alısır Ecder S, Arslan Gulen T, Atan Ucar Z, Karabay O et al: Surveillance of hemodialysis related infections: a prospective multicenter study. Sci Rep 2022, 12(1):22240.\u003c/li\u003e\n\u003cli\u003eBossola M, Mariani I, Antocicco M, Pepe G, Di Stasio E: Frailty, All-Cause Mortality, and Hospitalization in Patients on Maintenance Hemodialysis: A Systematic Review and Meta-Analysis. J Clin Med 2025, 14(14).\u003c/li\u003e\n\u003cli\u003eChattopadhyay T, Banerjee A, Mondal H: Causes of Hospitalization in Patients on Maintenance Hemodialysis with Arteriovenous Fistula in a Tertiary Care Hospital in West Bengal, India. Saudi Journal of Kidney Diseases and Transplantation 2021, 32(5).\u003c/li\u003e\n\u003cli\u003eHess S, Bren V: Essential Components of an Infection Prevention Program for Outpatient Hemodialysis Centers. Seminars in Dialysis 2013, 26(4):384-398.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization: Surveillance of health care-associated infections at national and facility levels: practical handbook. URL: https://iris.who.int/bitstream/handle/10665/379248/9789240101456-eng.pdf (Last accessed August 1, 2025). 2024.\u003c/li\u003e\n\u003cli\u003eNguyen DB, Shugart A, Lines C, Shah AB, Edwards J, Pollock D, Sievert D, Patel PR: National Healthcare Safety Network (NHSN) Dialysis Event Surveillance Report for 2014. Clin J Am Soc Nephrol 2017, 12(7):1139-1146.\u003c/li\u003e\n\u003cli\u003eAl-Qahtani M, El-Saed A, Alsheddi F, Alamri AH, Shibl AM, Alanazi KH: Infection control Surveillance of dialysis events at outpatient hemodialysis centers in Saudi Arabia: A 3-year national data. Infect Prev Pract 2025, 7(1):100447.\u003c/li\u003e\n\u003cli\u003eEl-Saed A, Sayyari A, Hejaili F, Sallah M, Dagunton N, Balkhy H: Higher access-associated bacteremia but less hospitalization among Saudi compared with US hemodialysis outpatients. Semin Dial 2011, 24(4):460-465.\u003c/li\u003e\n\u003cli\u003eAbdelfattah RR, Al-Jumaah S, Al-Korbi L, Al-Qahtani T: Three years\u0026apos; experience of dialysis event surveillance. Am J Infect Control 2019, 47(7):793-797.\u003c/li\u003e\n\u003cli\u003eRamadan MA, Hebbar G: A Retrospective Analysis of Dialysis Events over a 3-Year Period in an Outpatient Dialysis Unit in the State of Kuwait. Med Princ Pract 2018, 27(4):337-342.\u003c/li\u003e\n\u003cli\u003eBadawy DA, Mowafi HS, Al-Mousa HH: Surveillance of dialysis events: 12-month experience at five outpatient adult hemodialysis centers in Kuwait. J Infect Public Health 2014, 7(5):386-391.\u003c/li\u003e\n\u003cli\u003eZhang H, Li L, Jia H, Liu Y, Wen J, Wu A, Lu Q, Hou T, Yang Y, Yang H et al: Surveillance of Dialysis Events: one-year experience at 33 outpatient hemodialysis centers in China. Scientific Reports 2017, 7(1):249.\u003c/li\u003e\n\u003cli\u003eShamas N, Khamis F, Eljaaly K, Al Salmi Z, Al Bahrani M: Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed. Antimicrob Steward Healthc Epidemiol 2024, 4(1):e2.\u003c/li\u003e\n\u003cli\u003eB\u0026ouml;hlke M, Uliano G, Barcellos FC: Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access 2015, 16(5):347-355.\u003c/li\u003e\n\u003cli\u003eArhuidese IJ, Orandi BJ, Nejim B, Malas M: Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg 2018, 68(4):1166-1174.\u003c/li\u003e\n\u003cli\u003eMcCann M, Clarke M, Mellotte G, Plant L, Fitzpatrick F: Vascular access and infection prevention and control: a national survey of routine practices in Irish haemodialysis units. Clinical Kidney Journal 2013, 6(2):176-182.\u003c/li\u003e\n\u003cli\u003eOkubo A, Doi T, Yamada Y, Morii K, Nishizawa Y, Yamashita K, Fudaba Y, Shigemoto K, Mizuiri S, Usui K et al: Early arteriovenous fistula failure associated with mortality and major adverse cardiovascular events in patients undergoing incident hemodialysis. J Vasc Access 2025, 26(1):175-181.\u003c/li\u003e\n\u003cli\u003eKlevens RM, Edwards JR, Andrus ML, Peterson KD, Dudeck MA, Horan TC: Dialysis Surveillance Report: National Healthcare Safety Network (NHSN)-data summary for 2006. Semin Dial 2008, 21(1):24-28.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Dialysis events and outcomes by vascular access in patients receiving dialysis in four dialysis centers over 18 months\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 240px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cstrong\u003eArteriovenous fistula\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cstrong\u003eArteriovenous graft\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 96px;\"\u003e\u003cstrong\u003eCVC\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of events\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eOverall dialysis events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e541\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eIn-unit IV antimicrobial start\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e484\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eIn-unit IV vancomycin start\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003ePositive blood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLocal access site infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eAccess-related bloodstream infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eVascular access infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLoss of vascular access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHospitalization/death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of follow up months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eRiyadh-North\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e5260\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eRiyadh-South\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2680\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e4983\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eMadinah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e686\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1909\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eJeddah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2094\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eAll centers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e8062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e7265\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e15859\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRate per 100 patient-months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e*Rate by dialysis event\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eOverall dialysis events\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eIn-unit IV antimicrobial start\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e5.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eIn-unit IV vancomycin start\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003ePositive blood culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLocal access site infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eAccess-related bloodstream infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eVascular access infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e*Rate by outcome\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eLoss of vascular access\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHospitalization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eDeath\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 240px;\"\u003e\n \u003cp\u003eHospitalization/death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIV, intravenous; CVC, Central venous catheter \u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Benchmarking of dialysis events relative to the US National Healthcare Safety Network\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRates of current study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI of current study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRates of NHSN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentile bench-marking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eObserved number of events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExpected number of events\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized infection ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIn-unit IV antimicrobial start\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Fistulas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.91-1.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.25-4.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e5.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4.68-5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e7.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.78-3.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive blood culture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Fistulas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.08-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.00-1.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.21-2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.11-1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocal access site infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Fistulas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.01-0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.00-0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.13-1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e2.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.55-0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess-related bloodstream infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Fistulas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.00-0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.00-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e75th-90th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.89-2.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.89-1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular access infection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Fistulas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.03-0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAV Graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0.00-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2.89-3.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e4.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1.38-1.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 78px;\"\u003e\n \u003cp\u003e50th-75th\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 74px;\"\u003e\n \u003cp\u003e345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCI, confidence interval; NHSN, National Healthcare Safety Network; AV, arteriovenous; IV, intravenous; CVC, Central venous catheter\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Demographic and clinical characteristics of patients with dialysis events by hospitalization/death status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHospitalization/death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDialysis center\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eRiyadh-North\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e252 (46.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e167 (66.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e85 (33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eRiyadh-South\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e162 (29.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e102 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e60 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMadinah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e40 (7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e25 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e15 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eJeddah\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e87 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e42 (48.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e45 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e60.1\u0026plusmn;16.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e60.0\u0026plusmn;17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e60.1\u0026plusmn;14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.955\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026lt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e248 (45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e147 (59.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e101 (40.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e60-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e146 (27.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e89 (61.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e57 (39.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026gt;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e147 (27.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e100 (68.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e47 (32.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e299 (55.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e187 (62.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e112 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e242 (44.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e149 (61.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e93 (38.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBody mass index\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e27.2\u0026plusmn;7.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e26.9\u0026plusmn;7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e27.8\u0026plusmn;6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of comorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMean\u0026plusmn;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e2.7\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e2.6\u0026plusmn;1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e2.8\u0026plusmn;1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e10 (1.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7 (70.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e3 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e1-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e414 (76.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e268 (64.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e146 (35.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e117 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e61 (52.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e56 (47.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eObesity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e189 (35.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e110 (58.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e79 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e344 (63.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e219 (63.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e125 (36.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e477 (88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e299 (62.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e178 (37.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAsthma or COPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e41 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e20 (48.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eCancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e21 (3.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (38.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e13 (61.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eIschemic heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e117 (21.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e60 (51.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e57 (48.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e24 (4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e16 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eDyslipidemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e59 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e39 (66.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e20 (33.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.503\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHypothyroidism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e30 (5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21 (70.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e9 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOther comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e130 (24.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e81 (62.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e49 (37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.957\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of dialysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e2.2 (1.2-5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.2 (1.3-4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2.2 (1.1-5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026le;3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e337 (63.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e217 (64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e120 (35.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026gt;3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e198 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e116 (58.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e82 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVascular access type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eCVC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e435 (80.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e250 (57.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e185 (42.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAV fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e92 (17.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e73 (79.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e19 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eAV graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e14 (2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e13 (92.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD, standard deviation; IQR, interquartile range; COPD, chronic obstructive pulmonary disease; AV, arteriovenous; CVC, Central venous catheter\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hemodialysis, vascular access, infection, hospitalization, complications","lastPublishedDoi":"10.21203/rs.3.rs-8356012/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8356012/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMonitoring dialysis events and outcomes are crucial for proper care of hemodialysis patients. Regular dialysis surveillance doesn\u0026rsquo;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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A retrospective chart-review study was conducted at four outpatients\u0026rsquo; dialysis centers in Saudi Arabia. Data were collected from patients\u0026rsquo; medical records. Dialysis events were documented according to the definitions of the US National Healthcare Safety Network (NHSN).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDuring 15,859 patient months of surveillance, 541 patients developed one or more dialysis events. The mean age was 60.1\u0026thinsp;\u0026plusmn;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and loss of vascular access (33.5% versus 1.0%, p\u0026thinsp;\u0026lt;\u0026thinsp;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).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"Rates and Outcomes of Dialysis Events Among Hemodialysis Outpatients in Saudi Arabia; 18 months Multicenter Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-23 00:34:06","doi":"10.21203/rs.3.rs-8356012/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-08T13:24:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167253580361497617884282795869283650993","date":"2026-01-29T16:47:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T11:24:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-27T16:19:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-25T14:10:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-25T14:08:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2025-12-14T05:17:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61acde68-59fd-43fa-9cda-58a83fca83ed","owner":[],"postedDate":"January 23rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T00:34:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-23 00:34:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8356012","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8356012","identity":"rs-8356012","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}