Efficacy of Thrombolysis with Urokinase Containing Locking Solutions for Thrombotic Dysfunction of Tunneled Hemodialysis Catheters: a Retrospective Single-Centre Cohort Study

Scriptie/Masterproef: Master's Thesis

Samenvatting

INTRODUCTION The use of tunneled cuffed hemodialysis catheters (TCC) is complicated by the development of thrombosis and catheter related bacteremia (CRB). The optimal locking solutions to prevent and treat these complications remain controversial. METHODS We retrospectively collected data on all TCC used between 2010 and 2014 at UZ Brussel Hemodialysis Unit. The rate of thrombotic dysfunction and CRB was compared according to the use of Citra-Lock™30% or TauroLock™-Hep500. We also retrospectively compared the efficacy of different treatment regimens with Urokinase locking solutions in catheters with thrombotic dysfunctions. The advantage of multiple administrations of Urokinase locking solutions was also investigated. RESULTS 148 patients had in total 773 thrombotic dysfunctions. Efficacy of Urokinase containing locking solutions was 80-90% with increases of mean blood flow of 54 ml/min. Mean aspiration (arterial) pressure was improved by 25 mmHg and mean outflow (venous) pressure decreased by 32 mmHg (all P<0.0001), with better results for more severely dysfunctional catheters. Multiple administrations for the same thrombotic event improved values if still abnormal after one administration (P<0.0001). Incidence rate of CRB was 0.23/1000 catheter days in this population. Incidence rate of thrombotic dysfunction was lower with Citra-Lock™30% vs with TauroLock™-Hep500 (1.76 vs 3.32/1000 catheter days; P=0.0003). CONCLUSION Urokinase was effective to treat TCC-related thrombotic dysfunction. Multiple administrations were more effective than one single administration only if normal function was not restored after the first treatment. Citra-Lock™30% seems to be more protective against TCC thrombosis compared to TauroLock™-Hep500.
Datum prijs2015
Originele taalEnglish
BegeleiderFlorence Bonkain (Promotor) & Karl Martin Wissing (Promotor)

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