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


METHODS
Case-control study.


METHODS
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.


METHODS
History of PICCs.


RESULTS
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).


CONCLUSIONS
Retrospective study, participants mostly white.


CONCLUSIONS
PICCs are commonly placed in patients with end-stage renal disease and are a strong independent risk factor for lack of functioning AVFs.
Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Mireille
M
El Ters
Gregory J
GJ
Schears
Sandra J
SJ
Taler
Amy W
AW
Williams
Robert C
RC
Albright
Bernice M
BM
Jenson
Amy L
AL
Mahon
Andrew H
AH
Stockland
Sanjay
S
Misra
Scott L
SL
Nyberg
Andrew D
AD
Rule
Marie C
MC
Hogan
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000379:methods; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies