Abstract: FR-PO761

Efficacy of Alteplase (tPA) 1 mg versus 2 mg in Restoring Hemodialysis Catheter Function: A Randomized Double-Blind Controlled Study

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Kadri, Albert, Windsor Regional Kidney Care Center, Windsor, Ontario, Canada
  • El Nekidy, Wasim, Cleveland Clinic - Abu Dhabi, Windsor, Ontario, Canada
  • Soong, Derrick, Windsor Regional Hospital, Windsor, Ontario, Canada
  • El-Masri, Maher M, University of Windsor, Windsor, Ontario, Canada
Background

Hemodialysis catheters (HDC) are used to provide vascular access to patients with Chronic Kidney Disease on hemodialysis (HD). Late thrombus formation can result in HDC occlusion leading to its malfunction. Data about optimal alteplase (tPA) dose required to restore HDC is scarce. The purpose of the study was to examine the effectiveness of the commonly used tPA dose of 2 mg as compared to 1mg in restoring HDC function

Methods

A double blind, randomized, controlled clinical trial was conducted on hemodialysis patients who required tPA use to restore their HDC function. Eligible consented patients were randomly assigned to either of the two study groups (tPA 2 mg or 1 mg). Patients were included if they: were ≥ 18 years of age at the time of the study, were receiving HD using HDC, and had no medical contradiction for tPA use.

Results

Forty eight consenting patients contributed a total of 252 observations that were allocated to either group A (2 mg) or group B (1mg) based on randomization. Given the clustered nature of the observation, randomization was observation-based as opposed to patient-based. The rate of clot resolution at the catheter site in the A group was 85.7% as opposed to 84.9% with an insignificant absolute risk reduction of only 0.8 % percentage (p = 0.5). There were only six catheter removals; three of which were related to catheter malfunction. Catheter stripping was documented in 10 of the 252 observations. Kaplan Meier results indicated that the median time to occlusion after tPA resolution of the first catheter occlusion was 192 and 120 days for groups A and B, respectively (Log rank = 0.499; p = 0.480). Cox regression analysis indicated no difference in the hazard of occlusion between the two groups (p = 0.267; HR = 0.72; 95% CI 0.40–1.3). Further, correlated logistic regression with generalized estimating equations on all 252 observations indicated no difference in the rate of post tPA clot resolution (p = 0.336; OR = 2.4, 95% CI 0.399-14.6) between the two groups.

Conclusion

tPA 1 mg is as effective as 2 mg in restoring HDC function. The use of the lower dose will result in significant cost reduction in hemodialysis units.

Funding

  • Private Foundation Support