Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement While Maintaining Procedure Benefits

BackgroundEmbedding peritoneal catheters far in advance of anticipated need may successfully commit patients to their modality choice and reduce central venous catheter use but can be complicated by excessive embedment periods and futile catheter placement.ObjectiveEmbedded catheter outcomes were studied to identify factors that minimize inordinate embedment time and futile placement while maintaining procedure benefits.MethodsClinical and laboratory data were examined in 107 patients with embedded catheters that were either externalized, remained embedded, or were futilely placed.ResultsExternalization of 84 catheters was performed after a median embedment period of 9.4 months. Flow dysfunction occurred in 14.3% of externalized catheters. Overall function rate was 98.8% after laparoscopic revision. One patient changed their mind about modality choice. Except for 1 patient hospitalized acutely in a facility unfamiliar with embedded catheters, none remaining on a peritoneal dialysis pathway initiated dialysis with a central venous catheter. Including catheters with extremely long embedment periods, the incidence of futile placement was 13.1%. Multiple regression analysis identified estimated glomerular filtration rate (eGFR) and serum albumin as the 2 variables best associated with catheter embedment duration (r2= 0.44, p < 0.0001). Diabetic nephropathy was statistically more likely to be associated with lower serum albumin values ( p < 0.0001); however, no association was noted between diabetic status and embedment duration ( p = 0.62).ConclusionsTiming of the embedment procedure should include appraisal of both eGFR and serum albumin. Appropriate consideration of these values together may help minimize excessive embedment periods and decrease futile placements while preserving procedure benefits.

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P0750ASSOCIATION OF SERUM POTASSIUM LEVELS WITH RAPID KIDNEY FUNCTION DECLINE IN PATIENTS WITH CONGENITAL SINGLE KIDNEY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0750 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

FLORICA GADALEAN ◽

Florina Parv ◽

Ligia Petrica ◽

SILVIA VELCIOV ◽

Cristina Anca Gluhovschi ◽

...

Keyword(s):

Regression Analysis ◽

Glomerular Filtration Rate ◽

Kidney Function ◽

Serum Potassium ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Plasma Potassium ◽

Lower Serum ◽

Kidney Function Decline ◽

Single Kidney

Abstract Background and Aims Hypokalemia is associated with progression of chronic kidney disease (CKD), although the possible underlying mechanisms are not well established. Several observational studies showed that low or even low to normal serum potassium levels predict the decline of kidney function in the general population. However, this hypothesis has not been yet investigated in patients with reduced nephron number as are congenital single kidney (cSK) patients. Our aim was to prospectively examine the association of plasma potassium with risk of rapid kidney function decline in a cSK patients’ cohort. Method A cohort of 67 consecutive patients with cSK (mean age = 44.4+/-15.7 years; males 29p (43.28%)), with a mean estimated glomerular filtration rate (eGFR) = 65.2+/-28 ml/min/1.73m2, were enrolled in this longitudinal observational study. We evaluated the associations of plasma potassium levels with longitudinal kidney function decline by estimated glomerular filtration rate (eGFR). The eGFR was assessed with CKD-EPI formula. The rapid kidney function decline was defined as a fall in eGFR of more than 5 ml/min/1.73 m2/year, according to the KDIGO guidelines. Results During a mean follow-up time of 20.16+/-9.3 months, 31.34% (21p) of patients presented decline of eGFR, with a fall of mean – 11.6+/-5.43 ml/min/1.73m2/year. In univariable regression analysis, the decline of eGFR was associated with baseline eGFR (R2=0.09, p=0.013), age (R2=0.31, p<0.001), male gender (R2=0.14, p=0.001), arterial hypertension (R2=0.17, p=0.001), diabetes mellitus (R2=0.13, p=0.003), coronary artery disease (R2=0.12, p=0.005), uric acid (R2=0.23, p<0.001), C-reactive protein (R2=0.09, p=0.011), proteinuria/24h (R2=0.14, p=0.002) and serum potassium (R2=0.29, p<0.001). The serum potassium levels were significantly lower in the group with rapid decline of eGFR, with a mean of 3.62+/-0.41 mmol/L vs. 4.51+/-0.74 mmol/L, p<0.001. In multivariable regression analysis, the association between lower serum potassium levels and risk of rapid eGFR decline remained significant (HR=1.65; 95%CI, 1.105-2.49; p=0.015). Conclusion These results suggest that lower serum potassium levels may play a role in rapid kidney function decline in the cSK population. Further research is required to assess whether the higher risk of kidney function decline in cSK individuals could be diminished when optimised serum potassium levels strictly.

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Predictors of Arteriovenous Fistula Failure: A Post Hoc Analysis of the FAVOURED Study

Kidney360 ◽

10.34067/kid.0002732020 ◽

2020 ◽

Vol 1 (11) ◽

pp. 1259-1269

Author(s):

Yong Pey See ◽

Yeoungjee Cho ◽

Elaine M. Pascoe ◽

Alan Cass ◽

Ashley Irish ◽

...

Keyword(s):

Central Venous Catheter ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Controlled Trial ◽

Laboratory Data ◽

Venous Catheter ◽

Central Venous ◽

Factors Associated ◽

Female Sex ◽

Post Hoc

BackgroundAn autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes.MethodsThis is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure.ResultsOf 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P=0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56).ConclusionsFemale sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.

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Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

Thrombosis Journal ◽

10.1186/s12959-021-00275-w ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Wanli Liu ◽

Lianxiang He ◽

Wenjing Zeng ◽

Liqing Yue ◽

Jie Wei ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Central Venous Catheter ◽

Venous Thrombosis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Venous Catheter ◽

Upper Extremities ◽

Central Venous ◽

D Dimer

Abstract Background The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer. Methods This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs. Conclusions PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

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Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities

10.21203/rs.3.rs-70843/v2 ◽

2021 ◽

Author(s):

Wanli Liu ◽

Lianxiang He ◽

Wenjing Zeng ◽

Liqing Yue ◽

Jie Wei ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Central Venous Catheter ◽

Venous Thrombosis ◽

Logistic Regression Analysis ◽

Multivariate Logistic Regression Analysis ◽

Venous Catheter ◽

Upper Extremities ◽

Central Venous ◽

D Dimer

Abstract Background: The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.Methods: This was a retrospective cohort study of 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and the D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated. Results: Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion tripled the risk of LEDVT and doubled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.Conclusion: PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.

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