Chronic Kidney Disease
Chronic kidney disease (CKD) is a rare condition which is defined as lasting and progressive kidney damage. The kidneys are responsible for filtering waste and fluids from the body. In advanced stages of the disease, the accumulation of excess waste and fluids can cause major health complications, such as kidney failure.
The symptoms of CKD include jaundice, nausea, liver diseases, high blood pressure, sleep issues, stunted growth, vitamin deficiencies, and others. Treatment may include high blood pressure, cholesterol, or anemia medications, diuretics, and vitamin supplements. These therapies can help to control symptoms, reduce complications, and slow disease progression. If the condition reaches “end-stage,” dialysis or a kidney transplant may be necessary.
A recent study has shown that many patients with moderate to advanced CKD are also being given peripherally inserted central catheters (PICCs) in the hospital. However, PICCs are actually not recommended for use in CKD patients by general CKD guidelines. The American Society of Nephrology recommends that a nephrologist is consulted before PICCs are utilized in patients between stage 3 and stage 5. This consultation, if utilized, could help guide medical professionals in deciding which patients would benefit from a PICC and which patients should not receive one.
The Study
Thie study investigated patients with PICCs in the Michigan Hospital Medicine Safety Consortium. 3.4% of all those receiving PICCs were also receiving hemodialysis (HD).
For HD, the preferred choice is an arteriovenous fistula. However, this procedure is much more likely to succeed if the CKD patient has not already had a PICC or other indwelling vascular catheter.
ICU patients with a PICC were 5.6% more likely to experience major complications. Patients in the medical ward with a PICC were 3.5% more likely to experience major complications. Between the two groups, overall complication rates were about the same.
Unfortunately, the researchers in this study could not determine nephrologist approval of the PICC placement. This is a limitation of this investigation.
However, the researchers concluded that guidelines need to be implemented and alternative strategies need to be offered in order to best serve CKD patients. Ultimately, education is the key to improving outcomes for this patient population. Increased learning and engagement by non-nephrologists could make a difference in patient lives.
This study was published in the Annals of Internal Medicine but you can also read more here.
