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Predicting tissue plasminogen activator use and success in in-center hemodialysis patients

Abstract

Introduction

Hemodialysis catheter malfunction is problematic. We aimed to determine clinical, catheter, and hemodialysis variables that predict: (i) catheter malfunction requiring recombinant tissue-plasminogen activator (TPA) treatment and (ii) the success of TPA administration.

Methods

Clinical, catheter, and hemodialysis variables were collected from a cohort of 559 catheters (141,526 catheter days) in 175 hemodialysis patients (2008-2011). Time to, and predictors of, catheter malfunction were determined for all catheters and primary catheters only, analyzed by Cox-proportional hazard model, multi-variable logistic regression model, and mixed-effect logistic regression models. Success of TPA use was determined immediately, next day, and two weeks after use.

Results

Shorter time to first TPA administration in all patient’s catheters was associated with increased body mass index (hazard ratio [HR] = 1.06, 1.01-1.11, p = 0.03) and being of black race (HR = 3.05, 1.65-5.67, p<0.01). Primary TPA administration success at two weeks among primary catheters was associated with increased mean peak venous pressure before TPA administration (odds ratio [OR] = 1.03, 1.01-1.06, p<0.01) and decreased mean of the lowest systolic blood pressure measure for the three dialysis sessions prior to TPA administration (OR = 0.95, 0.91-0.99, p = 0.02). TPA administration success at two weeks among all catheters was associated with decreasing body mass index (OR = 0.84, CI 0.73-0.96, p = 0.01) and having diabetes (OR = 7.19, 1.40-36.81, p = 0.02).

Conclusions

Both patient and dialysis predictors of TPA use and success were identified in this study, which may be useful for fine-tuning catheter management protocols to target hemodialysis patients at high risk of catheter malfunction.

Post author correction

Article Type: ORIGINAL RESEARCH ARTICLE

Article Subject: Dialysis

DOI:10.5301/jva.5000785

Authors

Sarah Daisy Kosa, Chenglin Ye, Lehana Thabane, Amiram Gafni, Charmaine E. Lok

Article History

Disclosures

Financial support: The design, implementation, analysis and interpretation of this project was by SDK and CL with funding supported by Roche Pharmaceuticals. Roche Pharmaceuticals did not have any input into the design, implementation, analysis, interpretation of this study or review of this manuscript prior to its submission for publication.
Conflict of Interest: CL and SDK received funding from Roche Pharmaceuticals to support part of this project. CY is a current employee of Genentech in Oncology Biostatistics, Genentech, South San Francisco, USA, but was not an employee of Genentech at the time the analyses were conducted. CL, CY and SDK have no other conflicts of interest to declare. AG, and LT have no conflicts of interest to declare.
Meeting presentation: Some preliminary findings were submitted to an international conference as a poster presentation: Kosa S, Lok C. Abstract: Predicting Tissue Plasminogen Activator Administration Success in Hemodialysis Patients. National Kidney Foundation (NKF) 2013 Spring Clinical Meetings, Orlando, Florida; 2013.

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Authors

Affiliations

  • University Health Network, Toronto General Hospital, Toronto, Ontario - Canada
  • Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario - Canada

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