Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas: A case-control study in hemodialysis patients

Mireille El Ters, Gregory J. Schears, Sandra J Taler, Amy W. Williams, Robert C. Albright, Bernice M. Jenson, Amy L. Mahon, Andrew H. Stockland, Sanjay Misra, Scott Nyberg, Andrew D Rule, Marie C Hogan

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Although an arteriovenous fistula (AVF) is the hemodialysis access of choice, its prevalence continues to be lower than recommended in the United States. We assessed the association between past peripherally inserted central catheters (PICCs) and lack of functioning AVFs. Study Design: Case-control study. Participants & Setting: Prevalent hemodialysis population in 7 Mayo Clinic outpatient hemodialysis units. Cases were without functioning AVFs and controls were with functioning AVFs on January 31, 2011. Predictors: History of PICCs. Outcomes: Lack of functioning AVFs. Results: On January 31, 2011, a total of 425 patients were receiving maintenance hemodialysis, of whom 282 were included in this study. Of these, 120 (42.5%; cases) were dialyzing through a tunneled dialysis catheter or synthetic arteriovenous graft and 162 (57.5%; controls) had a functioning AVF. PICC use was evaluated in both groups and identified in 30% of hemodialysis patients, with 54% of these placed after dialysis therapy initiation. Cases were more likely to be women (52.5% vs 33.3% in the control group; P = 0.001), with smaller mean vein (4.9 vs 5.8 mm; P < 0.001) and artery diameters (4.6 vs 4.9 mm; P = 0.01) than controls. A PICC was identified in 53 (44.2%) cases, but only 32 (19.7%) controls (P < 0.001). We found a strong and independent association between PICC use and lack of a functioning AVF (OR, 3.2; 95% CI, 1.9-5.5; P < 0.001). This association persisted after adjustment for confounders, including upper-extremity vein and artery diameters, sex, and history of central venous catheter (OR, 2.8; 95% CI, 1.5-5.5; P = 0.002). Limitations: Retrospective study, participants mostly white. Conclusion: PICCs are commonly placed in patients with end-stage renal disease and are a strong independent risk factor for lack of functioning AVFs.

Original languageEnglish (US)
Pages (from-to)601-608
Number of pages8
JournalAmerican Journal of Kidney Diseases
Volume60
Issue number4
DOIs
StatePublished - Oct 2012

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Arteriovenous Fistula
Renal Dialysis
Case-Control Studies
Catheters
Dialysis
Veins
Arteries
Central Venous Catheters
Ambulatory Care Facilities
Upper Extremity
Chronic Kidney Failure
Retrospective Studies
Maintenance
Transplants
Control Groups
Population

Keywords

  • arteriovenous fistula
  • Chronic kidney disease
  • dialysis access
  • end-stage renal disease
  • hemodialysis

ASJC Scopus subject areas

  • Nephrology

Cite this

Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas : A case-control study in hemodialysis patients. / El Ters, Mireille; Schears, Gregory J.; Taler, Sandra J; Williams, Amy W.; Albright, Robert C.; Jenson, Bernice M.; Mahon, Amy L.; Stockland, Andrew H.; Misra, Sanjay; Nyberg, Scott; Rule, Andrew D; Hogan, Marie C.

In: American Journal of Kidney Diseases, Vol. 60, No. 4, 10.2012, p. 601-608.

Research output: Contribution to journalArticle

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abstract = "Background: Although an arteriovenous fistula (AVF) is the hemodialysis access of choice, its prevalence continues to be lower than recommended in the United States. We assessed the association between past peripherally inserted central catheters (PICCs) and lack of functioning AVFs. Study Design: Case-control study. Participants & Setting: Prevalent hemodialysis population in 7 Mayo Clinic outpatient hemodialysis units. Cases were without functioning AVFs and controls were with functioning AVFs on January 31, 2011. Predictors: History of PICCs. Outcomes: Lack of functioning AVFs. Results: On January 31, 2011, a total of 425 patients were receiving maintenance hemodialysis, of whom 282 were included in this study. Of these, 120 (42.5{\%}; cases) were dialyzing through a tunneled dialysis catheter or synthetic arteriovenous graft and 162 (57.5{\%}; controls) had a functioning AVF. PICC use was evaluated in both groups and identified in 30{\%} of hemodialysis patients, with 54{\%} of these placed after dialysis therapy initiation. Cases were more likely to be women (52.5{\%} vs 33.3{\%} in the control group; P = 0.001), with smaller mean vein (4.9 vs 5.8 mm; P < 0.001) and artery diameters (4.6 vs 4.9 mm; P = 0.01) than controls. A PICC was identified in 53 (44.2{\%}) cases, but only 32 (19.7{\%}) controls (P < 0.001). We found a strong and independent association between PICC use and lack of a functioning AVF (OR, 3.2; 95{\%} CI, 1.9-5.5; P < 0.001). This association persisted after adjustment for confounders, including upper-extremity vein and artery diameters, sex, and history of central venous catheter (OR, 2.8; 95{\%} CI, 1.5-5.5; P = 0.002). Limitations: Retrospective study, participants mostly white. Conclusion: PICCs are commonly placed in patients with end-stage renal disease and are a strong independent risk factor for lack of functioning AVFs.",
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AU - Schears, Gregory J.

AU - Taler, Sandra J

AU - Williams, Amy W.

AU - Albright, Robert C.

AU - Jenson, Bernice M.

AU - Mahon, Amy L.

AU - Stockland, Andrew H.

AU - Misra, Sanjay

AU - Nyberg, Scott

AU - Rule, Andrew D

AU - Hogan, Marie C

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N2 - Background: Although an arteriovenous fistula (AVF) is the hemodialysis access of choice, its prevalence continues to be lower than recommended in the United States. We assessed the association between past peripherally inserted central catheters (PICCs) and lack of functioning AVFs. Study Design: Case-control study. Participants & Setting: Prevalent hemodialysis population in 7 Mayo Clinic outpatient hemodialysis units. Cases were without functioning AVFs and controls were with functioning AVFs on January 31, 2011. Predictors: History of PICCs. Outcomes: Lack of functioning AVFs. Results: On January 31, 2011, a total of 425 patients were receiving maintenance hemodialysis, of whom 282 were included in this study. Of these, 120 (42.5%; cases) were dialyzing through a tunneled dialysis catheter or synthetic arteriovenous graft and 162 (57.5%; controls) had a functioning AVF. PICC use was evaluated in both groups and identified in 30% of hemodialysis patients, with 54% of these placed after dialysis therapy initiation. Cases were more likely to be women (52.5% vs 33.3% in the control group; P = 0.001), with smaller mean vein (4.9 vs 5.8 mm; P < 0.001) and artery diameters (4.6 vs 4.9 mm; P = 0.01) than controls. A PICC was identified in 53 (44.2%) cases, but only 32 (19.7%) controls (P < 0.001). We found a strong and independent association between PICC use and lack of a functioning AVF (OR, 3.2; 95% CI, 1.9-5.5; P < 0.001). This association persisted after adjustment for confounders, including upper-extremity vein and artery diameters, sex, and history of central venous catheter (OR, 2.8; 95% CI, 1.5-5.5; P = 0.002). Limitations: Retrospective study, participants mostly white. Conclusion: PICCs are commonly placed in patients with end-stage renal disease and are a strong independent risk factor for lack of functioning AVFs.

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KW - arteriovenous fistula

KW - Chronic kidney disease

KW - dialysis access

KW - end-stage renal disease

KW - hemodialysis

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