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Prevalence of Central Vein Stenosis in Patients Referred for Vein Mapping
Fasika M Tedla1, Guerrier Clerger2, Dale Distant3
1Division of Nephrology.
Insights
Central vein stenosis affects 10% of patients with chronic kidney disease, particularly those with dialysis catheters or cardiac devices. This highlights the need for vigilance in hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Central vein stenosis is a common complication in patients undergoing hemodialysis.
- The exact prevalence of central vein stenosis in this population remains unclear.
- This study aimed to determine the prevalence of central vein stenosis in patients with chronic kidney disease (CKD) referred for vein mapping.
Purpose of the Study:
- To report the prevalence of central vein stenosis in patients with CKD.
- To identify clinical and demographic factors associated with central vein stenosis.
Main Methods:
- Retrospective study of 525 adult patients undergoing bilateral upper extremity venographic vein mapping (September 2011 - December 2015).
- Comparison of clinical and demographic characteristics between patients with and without stenosis.
- Logistic regression analysis to identify independent predictors of central vein stenosis.
Main Results:
- The overall prevalence of central vein stenosis was 10% (95% CI, 8% to 13%).
- Prevalence was higher (13%) in patients with tunneled central venous dialysis catheters.
- Independent risk factors included current tunneled hemodialysis catheters (OR, 14.5), cardiac rhythm devices (OR, 5.07), prior fistula/graft (OR, 3.28), and prior kidney transplant (OR, 18).
Conclusions:
- Central vein stenosis prevalence was 10% in this CKD cohort.
- Stenosis was more frequent in patients with tunneled hemodialysis catheters, cardiac rhythm devices, and a history of dialysis access or kidney transplant.
- These findings underscore the importance of monitoring for central vein stenosis in at-risk hemodialysis patients.
Background And Objectives:
Central vein stenosis is considered to be common in patients on hemodialysis but its exact prevalence is not known. In this study, we report the prevalence of central vein stenosis in patients with CKD referred for vein mapping.
Design, Setting, Participants, & Measurements:
We conducted a retrospective study of adult patients who had bilateral upper extremity venographic vein mapping from September 1, 2011 to December 31, 2015. Patients with and without stenosis were compared for differences in clinical or demographic characteristics. Multiple logistic regression was used to identify independent associations between patient characteristics and central vein stenosis.
Results:
There were 525 patients who underwent venographic vein mapping during the study period, 27% of whom were referred before initiation of hemodialysis. The mean age (±SD) and body mass index were 59 (±15) years and 28 (±7), respectively. Women accounted for 45% of patients; 82% were black. The prevalence of central vein stenosis was 10% (95% confidence interval [95% CI], 8% to 13%) for the whole group, and 13% (95% CI, 10% to 17%) among patients with tunneled central venous dialysis catheters. Current use of tunneled hemodialysis catheters (odds ratio [OR], 14.5; 95% CI, 3.25 to 65.1), presence of cardiac rhythm devices (OR, 5.07; 95% CI, 1.82 to 14.11), previous history of fistula or graft (OR, 3.28; 95% CI, 1.58 to 6.7), and history of previous kidney transplant (OR, 18; 95% CI, 4.7 to 68.8) were independently associated with central vein stenosis.
Conclusions:
In this population, the prevalence of central vein stenosis was 10% and was clustered among those with tunneled hemodialysis catheters, cardiac rhythm device, and previous history of dialysis access or transplant.
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