TY - JOUR
T1 - Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas
T2 - A case-control study in hemodialysis patients
AU - El Ters, Mireille
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 L.
AU - Rule, Andrew D.
AU - Hogan, Marie C.
N1 - Funding Information:
Support: This publication was supported by National Institutes of Health (NIH)/National Center for Research Resources CTSA grant UL1 RR024150 . Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
PY - 2012/10
Y1 - 2012/10
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.
AB - 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.
KW - Chronic kidney disease
KW - arteriovenous fistula
KW - dialysis access
KW - end-stage renal disease
KW - hemodialysis
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U2 - 10.1053/j.ajkd.2012.05.007
DO - 10.1053/j.ajkd.2012.05.007
M3 - Article
C2 - 22704142
AN - SCOPUS:84866385182
SN - 0272-6386
VL - 60
SP - 601
EP - 608
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 4
ER -