PURPOSE: Hemodialysis central venous catheters (CVCs) are increasingly used, despite a prevalence target of <10%. The primary aim of our study was to understand why patients persistently use their CVCs. METHODS: A multicenter prospective observational study surveyed 322 patients and their vascular access coordinators (VACs) to determine the reasons patients use CVCs. Their responses were compared using multirater kappa statistics. An 18-month follow-up survey was applied to a subgroup of patients consistently using their CVCs, and correlated with the VACs' and patients' previous responses. Predictive associations for specific reasons for CVC use were explored. RESULTS: Patients indicated "non-medical" reasons (34.8%), having previously failed fistulas/grafts (25.8%), and fear of disfiguration (11.5%) as the main reasons for CVC use. The VAC was in agreement with the patient 16.5% of the time, in partial agreement 37.0%, and in disagreement 46.5%. Twelve percent of patients indicated a desire to change their CVC, yet the VAC was unaware of this 78% of the time. CONCLUSIONS: The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.
PURPOSE: Hemodialysis central venous catheters (CVCs) are increasingly used, despite a prevalence target of <10%. The primary aim of our study was to understand why patients persistently use their CVCs. METHODS: A multicenter prospective observational study surveyed 322 patients and their vascular access coordinators (VACs) to determine the reasons patients use CVCs. Their responses were compared using multirater kappa statistics. An 18-month follow-up survey was applied to a subgroup of patients consistently using their CVCs, and correlated with the VACs' and patients' previous responses. Predictive associations for specific reasons for CVC use were explored. RESULTS:Patients indicated "non-medical" reasons (34.8%), having previously failed fistulas/grafts (25.8%), and fear of disfiguration (11.5%) as the main reasons for CVC use. The VAC was in agreement with the patient 16.5% of the time, in partial agreement 37.0%, and in disagreement 46.5%. Twelve percent of patients indicated a desire to change their CVC, yet the VAC was unaware of this 78% of the time. CONCLUSIONS: The primary reasons patients use CVCs are "non-medical" followed by concerns with the complications and esthetic appearance associated with fistulas/grafts. The significant discordance between the reasons the patients give and the VAC's view of patient reasons for CVC use suggests a gap in knowledge, understanding, or communication between patients and their VACs. Timely predialysis education to address this gap and realistic targets are necessary to reduce CVC prevalence.
Authors: Charmaine E Lok; Jessica M Sontrop; George Tomlinson; Dheeraj Rajan; Mark Cattral; George Oreopoulos; Jeremy Harris; Louise Moist Journal: Clin J Am Soc Nephrol Date: 2013-01-31 Impact factor: 8.237
Authors: Louise M Moist; Charmaine E Lok; Tushar J Vachharajani; Wang Xi; Ahmed AlJaishi; Kevan R Polkinghorne; Miguel Vazquez; Timmy C Lee Journal: Semin Dial Date: 2012 Nov-Dec Impact factor: 3.455
Authors: S Daisy Kosa; Amiram Gafni; Andrew A House; JulieAnn Lawrence; Louise Moist; Bharat Nathoo; Paul Tam; Alicia Sarabia; Lehana Thabane; George Wu; Charmaine E Lok Journal: Kidney Int Rep Date: 2016-11-08