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Peripherally Inserted Central Catheters and Hemodialysis Outcomes.
Rita L McGill1, Robin Ruthazer2, Klemens B Meyer1
1Division of Nephrology, Tufts Medical Center, Boston, Massachusetts; and.
Summary
Peripherally inserted central catheters (PICCs) are common in hemodialysis patients but linked to worse vascular access outcomes. Clinicians should recognize potential long-term adverse effects of PICCs in chronic kidney disease (CKD) patients.
Area of Science:
- Nephrology
- Vascular Access Management
- Medical Device Outcomes
Background:
- Peripherally inserted central catheters (PICCs) use is increasing.
- Consequences of PICCs for hemodialysis patients are not well-defined.
Purpose of the Study:
- To analyze the association between peripherally inserted central catheter (PICC) placement and outcomes in patients initiating hemodialysis.
- To evaluate the impact of PICCs on transition to arteriovenous fistulas or grafts and patient survival.
Main Methods:
- National, population-based analysis of 33,918 adult Medicare beneficiaries initiating hemodialysis.
- Used linked Medicare claims to identify PICC exposures.
- Cox model with time-dependent variables to assess associations.
Main Results:
- 12.6% of patients received at least one PICC.
- PICC placement, both before and after hemodialysis initiation, was associated with a lower likelihood of transitioning to a working fistula or graft.
- Patients receiving PICCs were more likely to be female, have comorbidities, and less likely to have received predialysis nephrology care.
Conclusions:
- Peripherally inserted central catheter placement is common and linked to adverse vascular access outcomes.
- Clinicians must recognize the potential long-term adverse consequences of PICCs in chronic kidney disease patients.
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