Introduction: Kidney Disease Outcomes Quality Initiative clinical practice guidelines recommend avoiding placement of peripherally inserted vascular access devices in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. On the other hand, many patients with severe chronic kidney disease (CKD) have poor prognosis.This study carried out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) and Beclap score in patients with PICCs or Midlines, assuming that in those with an estimated high mortality rate at 2 years, it could be acceptable to implant a peripheral vascular access device (PVAD) despite the presence of CKD. Methods: We analyzed data on patients with PICCs or Midlines inserted from October 2018 to November 2019. CCI, Beclap score, and eGFR were calculated for each patient at the time of the catheter insertion. We then followed patients for 2 years to assess 2-year mortality for each. Results: One hundred and thirty-one patients were enrolled, 49 (37.4%) had eGFR<45 ml. The 2-year mortality rate was 57.3%. The cut off derived from ROC curve analysis of 15 for Beclap score and 5 for CCI, showed good sensitivity and specificity in predicting mortality of the total population, patients without an oncological disease and patients with eGFR<45 ml/min. Conclusion: CCI and Beclap score are good predictors of mortality at 2 years.Physicians and nurses can use these tools in the evaluation of patients at risk for future dialysis, instead of relying exclusively on renal function to decide whether implanting PICCs, Midlines, or other vascular access devices.

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study / A. Bartoli, M. Gallieni, C. Cogliati, F. Casella, M. Calloni, C. Melchionda, M. Heidempergher, A. Foschi, A. Luca Brucato, G. Rizzi, M. Quici, A. Gidaro. - In: JOURNAL OF VASCULAR ACCESS. - ISSN 1129-7298. - (2023). [Epub ahead of print] [10.1177/11297298231152499]

A decision-making algorithm proposal for PICCs and midlines insertion in patients with advanced kidney disease: A pilot study

A. Bartoli
Primo
;
M. Gallieni
Secondo
;
C. Cogliati;A. Luca Brucato;M. Quici;
2023

Abstract

Introduction: Kidney Disease Outcomes Quality Initiative clinical practice guidelines recommend avoiding placement of peripherally inserted vascular access devices in patients with an estimated glomerular filtration rate (eGFR) <45 ml/min. On the other hand, many patients with severe chronic kidney disease (CKD) have poor prognosis.This study carried out a global assessment of mortality at 2 years through Charlson Comorbidity Index (CCI) and Beclap score in patients with PICCs or Midlines, assuming that in those with an estimated high mortality rate at 2 years, it could be acceptable to implant a peripheral vascular access device (PVAD) despite the presence of CKD. Methods: We analyzed data on patients with PICCs or Midlines inserted from October 2018 to November 2019. CCI, Beclap score, and eGFR were calculated for each patient at the time of the catheter insertion. We then followed patients for 2 years to assess 2-year mortality for each. Results: One hundred and thirty-one patients were enrolled, 49 (37.4%) had eGFR<45 ml. The 2-year mortality rate was 57.3%. The cut off derived from ROC curve analysis of 15 for Beclap score and 5 for CCI, showed good sensitivity and specificity in predicting mortality of the total population, patients without an oncological disease and patients with eGFR<45 ml/min. Conclusion: CCI and Beclap score are good predictors of mortality at 2 years.Physicians and nurses can use these tools in the evaluation of patients at risk for future dialysis, instead of relying exclusively on renal function to decide whether implanting PICCs, Midlines, or other vascular access devices.
Beclap score; Charlson Comorbidity Index (CCI); Chronic kidney disease (CKD); midlines catheters; mortality; peripherally inserted central catheters (PICCs)
Settore MED/09 - Medicina Interna
Settore MED/14 - Nefrologia
2023
1-feb-2023
Article (author)
File in questo prodotto:
File Dimensione Formato  
Bartoli-Gidaro. Figure 3. JVA 2023.pdf

accesso aperto

Descrizione: Figure 3. Algoritm
Tipologia: Altro
Dimensione 26.95 kB
Formato Adobe PDF
26.95 kB Adobe PDF Visualizza/Apri
Bartoli-Gidaro. Figure 1 and 2. JVA 2023.pdf

accesso aperto

Descrizione: Figures 1 and 2
Tipologia: Altro
Dimensione 127 kB
Formato Adobe PDF
127 kB Adobe PDF Visualizza/Apri
Bartoli-Gidaro. PICCs in CKD. JVA 2023 text.pdf

accesso aperto

Descrizione: Manuscript
Tipologia: Post-print, accepted manuscript ecc. (versione accettata dall'editore)
Dimensione 175.22 kB
Formato Adobe PDF
175.22 kB Adobe PDF Visualizza/Apri
Bartoli.+TAB+1+JVA+2023.pdf

accesso aperto

Tipologia: Altro
Dimensione 42.41 kB
Formato Adobe PDF
42.41 kB Adobe PDF Visualizza/Apri
11297298231152499.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 566.08 kB
Formato Adobe PDF
566.08 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/954192
Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 0
social impact