Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis
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Publication Date: | 2017 |
Other Authors: | , , , |
Format: | Article |
Language: | eng |
Source: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Download full: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002 |
Summary: | 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 |
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Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysisBacteraemiaCathetersCitric AcidDialysisPlasminogen ActivatorsThrombosisIntroduction: 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 groupsSociedade Portuguesa de Nefrologia2017-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002Portuguese Journal of Nephrology & Hypertension v.31 n.2 2017reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002Magriço,RitaSantos,José PauloColaço,SusanaDias,SaraRamos,Aurainfo:eu-repo/semantics/openAccess2024-02-06T17:04:55Zoai:scielo:S0872-01692017000200002Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:58.271367Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
title |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
spellingShingle |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis Magriço,Rita Bacteraemia Catheters Citric Acid Dialysis Plasminogen Activators Thrombosis |
title_short |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
title_full |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
title_fullStr |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
title_full_unstemmed |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
title_sort |
Recombinant tissue plasminogen activator plus citrate versus citrate alone as catheter lock for tunnelled catheters of haemodialysis |
author |
Magriço,Rita |
author_facet |
Magriço,Rita Santos,José Paulo Colaço,Susana Dias,Sara Ramos,Aura |
author_role |
author |
author2 |
Santos,José Paulo Colaço,Susana Dias,Sara Ramos,Aura |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Magriço,Rita Santos,José Paulo Colaço,Susana Dias,Sara Ramos,Aura |
dc.subject.por.fl_str_mv |
Bacteraemia Catheters Citric Acid Dialysis Plasminogen Activators Thrombosis |
topic |
Bacteraemia Catheters Citric Acid Dialysis Plasminogen Activators Thrombosis |
description |
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 |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-06-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000200002 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.31 n.2 2017 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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