Saving Veins, Saving Lives, for Patients With Chronic Kidney Disease
Authors: Marcia R. Silver
Journal: Annals of Internal Medicine (2019)

Editorials2 July 2019Saving Veins, Saving Lives, for Patients With Chronic Kidney DiseaseMarcia R. Silver, MDMarcia R. Silver, MDCase Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio (M.R.S.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-1086 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Vascular access has long been recognized as the Achilles' heel of the management of patients receiving maintenance hemodialysis. Such patients require cannulation with 15-gauge needles 3 times weekly, blood flows of about 400 mL/min, and treatments of 4 to 5 hours per session. This requires creation of arteriovenous fistulae using native veins or arteriovenous grafts using synthetic vein material. Absent usable vessels or time to surgically create and allow maturation of internal access for dialysis, clinicians use large-bore, dual-lumen, tunneled, cuffed dialysis catheters placed in the internal jugular vein. Robust data show that mortality among patients receiving dialysis with catheters ...References1. Held PJ, Brunner F, Odaka M, et al. Five-year survival for end-stage renal disease patients in the United States, Europe, and Japan, 1982 to 1987. Am J Kidney Dis. 1990;15:451-7. [PMID: 2333867] CrossrefMedlineGoogle Scholar2. Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis. 2009;53:475-91. [PMID: 19150158] doi:10.1053/j.ajkd.2008.10.043 CrossrefMedlineGoogle Scholar3. Chapter 3: vascular access. In: United States Renal Data System 2018 Annual Data Report. Vol. 2. Accessed at www.usrds.org/2018/view/v2_03.aspx on 28 March 2019. Google Scholar4. Paje D, Rogers MAM, Conlon A, et al. Use of peripherally inserted central catheters in patients with advanced chronic kidney disease. A prospective cohort study. Ann Intern Med. 2019;171:10-8. doi:10.7326/M18-2937 LinkGoogle Scholar5. Nguyen V, Ball L. Exceeding DOQI A-V fistula target at the Northwest Renal Network 16: is 80-90% A-V fistula rate achievable? [Letter]. Semin Dial. 2014;27:E66-70. [PMID: 25376556] doi:10.1111/sdi.12171 CrossrefMedlineGoogle Scholar6. Silver MR, Cain JA. Managing the lifeline: preemptive access management for better outcomes for hemodialysis patients and programs. Medical Review Board of The Renal Network, Inc. Adv Ren Replace Ther. 2000;7:S45-55. [PMID: 11053587] MedlineGoogle Scholar7. Ofri D. Perchance to think. N Engl J Med. 2019;380:1197-9. [PMID: 30917257] doi:10.1056/NEJMp1814019 CrossrefMedlineGoogle Scholar8. Tangri N, Stevens LA, Griffith J, et al. A predictive model for progression of chronic kidney disease to kidney failure. JAMA. 2011;305:1553-9. [PMID: 21482743] doi:10.1001/jama.2011.451 CrossrefMedlineGoogle Scholar9. Sasadeusz KJ, Trerotola SO, Shah H, et al. Tunneled jugular small-bore central catheters as an alternative to peripherally inserted central catheters for intermediate-term venous access in patients with hemodialysis and chronic renal insufficiency. Radiology. 1999;213:303-6. [PMID: 10540677] CrossrefMedlineGoogle Scholar10. Rosenberg M. Overview of the management of chronic kidney disease in adults. In: Post TW, eds. UpToDate. Waltham, MA: UpToDate; 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, Ohio (M.R.S.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-1086.Corresponding Author: Marcia R. Silver, MD, Case Western Reserve University School of Medicine at MetroHealth Medical Center, Division of Nephrology and Hypertension, G-530, 2500 MetroHealth Drive, Cleveland, OH 44109-1998; e-mail, Marcia.[email protected]edu.This article was published at Annals.org on 4 June 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoUse of Peripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney Disease David Paje , Mary A.M. Rogers , Anna Conlon , Scott A. Flanders , Steven J. Bernstein , and Vineet Chopra Metrics Cited byPeripherally Inserted Central Catheters in Patients With Advanced Chronic Kidney DiseaseEdward L. Goodman, MD 2 July 2019Volume 171, Issue 1Page: 60-61KeywordsCathetersDecision makingForecastingMedical dialysisMedicareMortalityNephrologyPeripherally inserted central cathetersRenal systemVeins ePublished: 4 June 2019 Issue Published: 2 July 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...