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Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

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Abstract

Hemodialysis (HD) catheter occlusion is a common cause of poor blood flow and inadequate dialysis. In order to address this problem in our pediatric dialysis unit, we elected to use short (2-h) infusions of low-dose recombinant tissue plasminogen activator (rtPA) for thrombolysis of occluded catheters. Catheters meeting diagnostic criteria for thrombosis were infused with 2.5 mg rtPA in 25 ml 0.9 normal saline over 2 h prior to dialysis. Retrospective data collection was carried out to assess the success of this procedure. Variables assessed included blood flow (Qb), transmembrane pressure (TMP) and venous pressure (VP) before and after rtPA infusion. Seven catheter thromboses in six patients were successfully treated with rtPA; there were significant improvements in Qb ( p <0.01), TMP ( p <0.01), and VP ( p <0.02). At 32 weeks after rtPA therapy, Kaplan-Meier survival analysis showed a 60% probability of primary catheter patency. At the end of the study, 85% of catheters had adequate function as defined by a Qb >200 ml/min. No adverse events were observed. Low-dose rtPA infusion is safe and effective for catheter thrombolysis in outpatient pediatric HD patients. It may serve as an alternative method of administration to local instillation and may be used to restore patency before resorting to surgical revisions.

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Acknowledgements

This study was presented in an abstract form at the 22nd Annual Conference on Peritoneal Dialysis and the 8th International Symposium on Hemodialysis, Tampa, Florida, March 2002. Fatai O. Bamgbola was supported by NIDDK Training Grant #9-526-3740. We appreciate the assistance of Dr. Martin Turman for his assistance in proofreading the manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Nephrology, Oklahoma University Health Science Center, 940 NE 13th Street, Oklahoma, OK 73104, USA

    Oluwatoyin F. Bamgbola

  2. Division of Pediatric Nephrology, Children’s Hospital at Montefiore, 111 East 210th Street, Bronx, NY, USA

    Marcela del Rio, Frederick J. Kaskel & Joseph T. Flynn

Authors
  1. Oluwatoyin F. Bamgbola
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  2. Marcela del Rio
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  3. Frederick J. Kaskel
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  4. Joseph T. Flynn
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Correspondence to Oluwatoyin F. Bamgbola.

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Bamgbola, O.F., del Rio, M., Kaskel, F.J. et al. Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance. Pediatr Nephrol 20, 989–993 (2005). https://doi.org/10.1007/s00467-004-1797-1

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  • DOI: https://doi.org/10.1007/s00467-004-1797-1

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