Peripheral central catheter insertion in low eGFR patients: Retrospective single institution study

Area of Science:

• Nephrology
• Vascular Access
• Medical Device Placement

Background:

• Chronic kidney disease (CKD) affects millions globally, often requiring advanced interventions.
• Peripherally Inserted Central Catheters (PICCs) are frequently used for vascular access in patients with deteriorating kidney function.
• Understanding the outcomes of PICC placement in CKD patients is crucial for optimizing care.

Purpose of the Study:

• To determine the frequency of Peripherally Inserted Central Catheter (PICC) placement in patients with stage 3B or higher chronic kidney disease (CKD).
• To analyze the association between low estimated glomerular filtration rate (eGFR) and outcomes following PICC insertion.

Main Methods:

• Retrospective analysis of 2825 adult patients undergoing PICC insertion between January 2017 and December 2019.
• Data collected included patient demographics, eGFR at insertion, vein access, and subsequent dialysis or death within one year.
• Statistical analysis compared outcomes between patients with eGFR <45 mL/min/1.73 m² and those with eGFR >45 mL/min/1.73 m².

Main Results:

• PICC insertion occurred in 26.7% of patients with eGFR ≤45 mL/min/1.73 m².
• Patients with low eGFR (<45) had a significantly higher 1-year mortality rate (57%) compared to those with higher eGFR (31.8%).
• The rate of new dialysis initiation within one year was significantly higher in low eGFR patients not previously on dialysis (19%) versus higher eGFR patients (2.9%).

Conclusions:

• PICC insertion is frequently performed in patients with advanced CKD.
• Lower eGFR is associated with increased mortality and a higher likelihood of requiring dialysis post-PICC placement.
• Clinical guidelines should be reinforced to optimize PICC use and preserve venous access for future arteriovenous fistula creation.