Nephrology and Hypertension Division, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Am J Kidney Dis. 2012 Oct;60(4):601-8. doi: 10.1053/j.ajkd.2012.05.007. Epub 2012 Jun 15.
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.
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.
History of PICCs.
Lack of functioning AVFs.
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).
Retrospective study, participants mostly white.
PICCs are commonly placed in patients with end-stage renal disease and are a strong independent risk factor for lack of functioning AVFs.
动静脉瘘（AVF）是血液透析的首选通路，但在美国其普及率仍低于推荐水平。我们评估了既往外周置入中心静脉导管（PICC）与 AVF 功能丧失之间的关系。
病例对照研究。
7 个梅奥诊所门诊血液透析单位的现患血液透析人群。病例组无功能 AVF，对照组于 2011 年 1 月 31 日有功能 AVF。
PICC 史。
无功能 AVF。
2011 年 1 月 31 日，共有 425 名患者接受维持性血液透析，其中 282 名纳入本研究。其中，120 名（42.5%；病例组）通过隧道透析导管或合成动静脉移植物进行透析，162 名（57.5%；对照组）有功能的 AVF。两组均评估了 PICC 的使用情况，并发现 30%的血液透析患者使用了 PICC，其中 54%在透析治疗开始后放置。病例组更可能为女性（52.5% vs 对照组 33.3%；P = 0.001），平均静脉（4.9 vs 对照组 5.8mm；P < 0.001）和动脉直径（4.6 vs 对照组 4.9mm；P = 0.01）均小于对照组。53 例（44.2%）病例中发现有 PICC，但对照组仅 32 例（19.7%）（P < 0.001）。我们发现 PICC 使用与无功能 AVF 之间存在强烈且独立的关联（OR，3.2；95%CI，1.9-5.5；P < 0.001）。这种关联在调整混杂因素（包括上肢静脉和动脉直径、性别和中心静脉导管史）后仍然存在（OR，2.8；95%CI，1.5-5.5；P = 0.002）。
回顾性研究，参与者多为白人。
PICC 常用于终末期肾病患者，是无功能 AVF 的一个强烈的独立危险因素。
