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Abstract: PO0937

Targeted Alteplase Administration to Improve Hemodialysis Catheter Patency: A Quality Improvement Pilot Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Bau, Jason T., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Harrison, Tyrone, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Younis, Kokab, Alberta Health Services, Calgary, Alberta, Canada
  • Gallagher, Nathen, Alberta Health Services, Calgary, Alberta, Canada
  • Hemmett, Juliya, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Qirjazi, Elena, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

Catheter dysfunction (CD) is a frequent complication during the provision of hemodialysis. Thrombolytic agents (i.e. alteplase) are the mainstay for resolving CD, however, alteplase usage has increased 16% (~$440,000CAD) annually in the Alberta Kidney Care South program without improved patient or dialysis outcomes. We assessed the implementation of a protocolized algorithm to reduce alteplase usage.

Methods

In this pilot quality improvement study, we designed an algorithm where CD was treated with high-dose (2mg) alteplase therapy to the problematic lumen only, after meeting pre-specified criteria (Fig 1). This protocol was implemented in a satellite hemodialysis unit (~110 patients) from Jan 2021 to Mar 2021. The baseline comparison period was Jan 2020 to Dec 2020 when CD was treated with low-dose 1mg/lumen alteplase. Outcome measures included total alteplase usage, changes in Kt/V, recirculation, clearance, line interventions and hospitalization rates. Statistical analysis was completed using Mann-Whitney and Z-score calculations.

Results

Sixty-nine alteplase administrations occurred over the two-month period, versus 438 in the baseline period. Patients in the 2mg group were more likely to achieve an increase in Kt/V of at least 10% in the next dialysis session (34.7% vs 28.9% p=0.04). Otherwise the 2mg alteplase with our protocol was not inferior to baseline with respect to blood volume processed (26.1% vs 20.1% p=0.13) and average clearance (37.7% vs 28.5% p=0.37). A 12% decrease (88 vs 100mg/mo p<0.05) in alteplase use was observed with no differences in frequency of hospitalizations (8% vs 5.9% p=0.39) or line interventions (12.3% vs 7.3% p=0.20).

Conclusion

Our protocol with 2mg alteplase therapy to the problematic lumen was not inferior with respect to patient outcomes compared to baseline practices and resulted in lower alteplase use. An expanded multi-center prospective study is underway to further assess the broader applicability of these findings.

Alteplase administration protocol.