Document Detail

Association between prior peripherally inserted central catheters and lack of functioning arteriovenous fistulas: a case-control study in hemodialysis patients.
MedLine Citation:
PMID:  22704142     Owner:  NLM     Status:  MEDLINE    
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.
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.
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 L Nyberg; Andrew D Rule; Marie C Hogan
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2012-06-15
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  60     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-18     Completed Date:  2013-01-01     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  601-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
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MeSH Terms
Arteriovenous Shunt, Surgical*
Case-Control Studies
Catheterization, Central Venous* / methods
Kidney Failure, Chronic / therapy*
Middle Aged
Renal Dialysis
Retrospective Studies
Grant Support
Comment In:
Am J Kidney Dis. 2012 Oct;60(4):510-3   [PMID:  22985979 ]

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