Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis

• Autor(a) principal: Magriço,Rita
• Data de Publicação: 2017
• Outros Autores: Santos,José Paulo, Colaço,Susana, Dias,Sara, Ramos,Aura
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002
• topic: Bacteraemia; Catheters; Citric Acid; Dialysis; Plasminogen Activators; Thrombosis

Introduction: The solution used to fill the lumens of the tunnelled catheters for haemodialysis (lock) influences catheter-related complications, such as inadequate blood flow and dialysis efficacy. It is unknown whether a lock strategy with weekly administration of Recombinant Tissue Plasminogen Activator (rt-PA) and of citrate during the remaining dialysis sessions is associated with better catheter blood flow and increased dialysis dose compared with citrate alone. Methods: We performed a prospective cross-over study in 16 patients to compare weekly administration of 1mg per catheter lumen of rt-PA and citrate 4% in the remaining sessions with citrate 4% administration in all dialysis sessions. Each lock strategy was performed for 24 weeks, separated by a 4-week wash-out period. We performed a random effects model and two paired t-tests (in each intervention group and in each patient) to compare the mean blood flow and single-pool Kt/V (spKt/V) of each dialysis session. Results: In the 8 patients eligible for comparison, blood flow was higher in the rt-PA group (380.73 ± 33.43 mL/min versus 368.86 ±34.86 mL/min; p-value <0.001). The mean increase in the random-effects model after adjustment for time was 13.79 mL/min (95% CI 10.23-17.34 mL/min). There was a high variability between subjects on the difference in blood flow achieved with the two lock strategies (non-significant in 4 subjects; from 8 to 51 mL/min in the remainder). Mean spKt/V value was 1.43 in the rt-PA group and 1.39 in the citrate-alone group. Conclusions: When compared with citrate alone, weekly administration of rt-PA was associated with higher blood flow and spKt/V. The clinical benefit of this intervention is questionable, since the mean increase in blood flow was 13.79 mL/min and in 4 out of 8 patients was not significant. Dose of dialysis achieved the recommended target in both groups